Leder efter "Intake Form" Template / Skabelon på dansk

Dear Members,

Does anyone if a good sample or template of a standard "Intake Form"? Much like one would fill out the first time visiting a physiotherapist or dentist?

We have started a full body treatment clinic at home and would like this for a number of reasons. These include being able to keep Clients' details on file (including GDPR allowance) and understanding any of their requested focus areas.

I have attached a sample I found in English.

Thanks in advance!