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Sending the Demographics form and Credit Card Information form

Sending the Demographics form and Credit Card Information form

The Demographics form and Credit Card Information form can be sent to clients to collect their contact and payment info via the Client Portal. In this guide, we’ll cover:


Demographics form

The Demographics form can be sent to your clients at any time. This form is an essential element of your paperless intake package, because it allows clients to provide their own demographic information via the Client Portal. Any information your client submits through the Demographics form automatically populates into their file in your account.

demopgrahicsform.simplepractice.clientportal.png

To complete the Demographics form, the client can click Demographics form and provide information for the following:

  • Legal first name
  • Legal last name
  • Middle name
  • Indicate if the client is a minor
  • Email address
  • Phone number
  • Address
  • Birthday
  • Sex
  • Relationship status
  • Employment status
  • Emergency contact information

Note: When completing the Demographics form in the Client Portal, clients can consent to or decline receiving email, text, and/or voice messages from your practice.

consent.simplepractice.demographicform.png  


Adding optional fields on the Demographics form

You can also select optional fields to include on your Demographic form for your clients to complete. The optional fields are:

What name do they go by?

  • This field allows the client to provide the name they that they go by in addition to their legal name. In your account, this name will appear in place of their legal first name on the Calendar homepage and their client Overview page.
  • Here’s what it looks like in the Client Portal:

whatnamedoyougoby.simplepractice.demographicform.png

Insurance

  • This field will allow the client to provide their insurance information, including a field to upload a picture of the front and back of their insurance card.
  • Here’s what it looks like in the Client Portal:

insurance.simplepractice.contactinfo.png

Gender identity

  • This field allows the client to provide their gender identity, pronouns they go by, and other important information. This is limited to 140 characters.
  • Here’s what it looks like in the Client Portal:

genderidentity.simplepractice.contactinfo.png

Note: The Sex field populates Box 3 of the CMS-1500 claim form. Insurance payers only accept Male or Female options in that box. If you choose not to offer the Gender Identity field, the client will only see the Sex field.

To add these optional fields in your Demographics form:

  • Navigate to Settings > Client Portal > Shared Documents and Files
  • Under Demographic & Credit Card forms, select the box(es) for Name they go by, Insurance, and/or Gender Identity

optional.simplepractice.demographicform.png

Going forward, the optional fields will be included in your Demographics form. If you already sent the Demographics form without these fields, you can delete your original request and resend it so that the optional fields will be included. For instructions on how to do this, see: What if I need to resend a form to a client?

Note: If you’d like to have an existing client update their insurance information through the Demographic Information form, you’ll need to delete their insurance information on file and re-send this form. See Setting up insurance billing for your clients to learn more about updating a client's insurance information. 

Tip: We recommend creating a test client and sending yourself the intake portal link so that you can see the Demographic from the client’s end.


Credit Card Information form

If you accept credit card payments, you can securely request credit card information using the Credit Card Information form. Watch the video below to learn more:

Note: The Credit Card Information form is only available if you have Online Payments enabled. For more information, see: Getting started with Online Payments.

When your clients save their credit card details using the Credit Card Information form, the stored information is encrypted. The full card number isn’t displayed or viewable by anyone in your account. 

Once the client fills out the Credit Card Information form, the type of card, the last 4 digits of the client’s card, and the expiration date will automatically appear on the client’s Billing and Insurance tab:

creditcard.simplepractice.billingandinsurance.png

Tip: If a client has multiple cards on file, we recommend setting a default card and adding a nickname.

To share the Credit Card Information form, enable Online Payments. Once enabled, you’ll be able to share the Credit Card Information form with a client at any time. To do this:

  • Navigate to the client’s Overview page
  • Click Share in the top right corner
  • Under Profile & Credit Card Forms, select the box for Credit Card Information

creditcardinformation.simplepractice.shareitems.png

  • Click Continue to Email and follow the prompts to send the email to the client

Important: The Credit Card Information form doesn’t include a signature box. If you need a Credit Card Authorization to process payments on the credit card, you’ll want to create it as a consent document and share it with your client for signature, along with the form. See Credit Card Authorization form for more details.

This is what the Credit Card Information form looks like in the Client Portal on the client’s end:

creditcardinformaiton.simplepractice.clientportal.png


Related resources

 

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