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

• Demographics form
• Adding optional fields on the Demographics form
• Credit Card Information form

Note: To learn more about the paperless intake process, see Sending intake forms and documents to clients.

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.

To complete this form in the Client Portal, the client can click Demographics form and provide the following information:

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

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

Any information your client submits through the Demographics form automatically populates into their file in your account. For more information on the client file, see Editing a client's information.

Adding optional fields on the Demographics form

You can also choose to include optional fields on the Demographic form for your clients to complete.

Name they go by

With this field, a client can provide the name that they go by in addition to their legal name. In your account, their preferred name will appear in place of their legal first name on the calendar, the client’s Overview page, and billing documents. The client’s legal name will appear on insurance claims.

Here’s what this field looks like in the Client Portal:

Insurance

If the Insurance section is included on the Demographics form, clients will be able to provide their insurance information, as well as upload pictures of the front and back of their insurance card.

This section won't appear on the Demographics form if a client has insurance information entered in their file. You can enter their new insurance information from the client's Overview > Edit > Billing and Insurance tab, or navigate to the client’s Files Overview page to delete and resend the Demographics form. For more information on this page, see Managing the client Files Overview page.

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

Here’s what it looks like in the Client Portal:

Note: This section also includes the What sex is on your insurance policy? field. This field populates on Box 3 of the CMS-1500 claim form. Insurance payers only accept Male or Female options in that box. 

Gender identity

This field allows the client to provide their gender identity, pronouns they use, and other important information. This is limited to 140 characters.

Here’s what it looks like in the Client Portal:

To add these optional fields in your Demographics form:

• Navigate to Settings > Documentation > Shareable documents
• Under Demographics and Credit Card Forms, check the box(es) for Name they go by, Insurance, and/or Gender Identity

Going forward, the optional fields will be included in your Demographics form. If you already requested the Demographics form without these fields, you can delete and resend it so that the optional fields will be included. For instructions on how to do this, see Managing the client Files Overview page.

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

Important: Credit card information should only be stored within the PCI compliant fields in your SimplePractice account. These include fields that are filled with the Credit Card Information form. Storing this information outside of these fields, or in any other manner, means you acknowledge the risk associated with storing this data within your account. For more on processing payments in a PCI compliant way, see ​​Processing Online Payments.

If you accept credit card payments, you can securely request credit card information using the Credit Card Information form. 

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:

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

• 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:

Clients can update their credit card information in the Client Portal by re-completing the Credit Card Information form. For more information on re-sending the Credit Card Information form, see Requesting credit card information via the Client Portal.