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The Intake Form

A clinic-style intake for one recurring struggle — chief complaint, history, allergies to advice, desired outcome. Distinct from the Second Opinion (referral about a decision already made): this is the first honest presentation of the problem. The tinted panel counts complaints with no desired outcome.

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Presenting a recurring struggle honestly — with a desired outcome on every complaint.
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Composed
A still life that evokes the The Intake Form

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Build your intake form

Step 01 · The intake

Step 02 · Complaints

One per line: complaint | history | allergy | outcome. Blank / — / none counts as no desired outcome.

Name the chief complaint.

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Filled example
Blank layout
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