Thoughts on setting clinic policies and writing forms

When you open your clinic, you will be the one to decide on your clinic policies and write your policy documents. This topic often gets overlooked when starting out, and forms often get quickly thrown together so that you can get started seeing patients. Instead, I encourage you to really think about your policies and carefully write your forms. Let's talk about why!

In this entry:

• What are clinic policies?
  • A surface definition, with examples of important policies
  • A deeper perspective of policies as a way of communicating with your patients
• Why are good forms important?
• Tips for writing your forms
• A quick case study
• Future policy deep dives

What are clinic policies?

Let's start with the more obvious, surface definition: your clinic policies are your clinic's rules, expectations, and penalties. These can include:

• Financial policies: explain what forms of payment you accept, how long people have to pay their balance, cancellation policy, no-show policy, insurance policies, inclement weather policies, fee schedule for cancellations and no-shows, etc.
• Informed consent: this describes your scope of practice, your forms of treatment, expectations for disclosure from your patient (such as medical history), policies for termination of care, etc.
• HIPAA/Privacy policies: describe how you safeguard your patients' information and their rights to their medical information. You may or may not be required to follow HIPAA, but you are responsible for keeping your patient's information private.
• State-specific policies: Some states mandate a form that you need to have patients sign.

Policies are a form of protection for you and your business, and written policies that patients sign are your policy forms. These forms are a legal agreement between you and your patients (which is something we often forget!) and serve as a way to protect you, your business, and your patients in the event something goes wrong. Following state-specific requirements protects your license, too. On the other hand, Privacy Policies and Informed Consent forms protect your patients, their safety, and their medical information.

Why are good forms important?

A well-written policy form does several things, some less obvious than others:

• It establishes what your policies are. (Obviously.) However, being clear gives people an idea of what they can expect when they visit your space, which can help build trust and reduce anxiety. It also can be more comfortable for people to know what to expect, especially if they are new to the modality.
• It communicates professionalism. A well-written form, free of grammatical errors and typos and formatted well, is essential. Sloppy forms make you look sloppy. If this is an area you struggle with, consider using a service like Grammarly (referral link, but I have used it for over 2 years) in your writing, or hire someone to write or proofread your forms.
• It protects you in the event of policy violations and/or liabilities. There will inevitably be moments when someone will not follow a policy. Having clear policies protects you -legally! - if you need to enforce your policy.
• It helps set boundaries and gives you a firm foundation for enforcing them. As practitioners, we are responsible for setting expectations for our interactions with patients while they are receiving care from us. When you're unsure what to do in a situation, you can look to your policy for the answer.

I also view my forms as a way to communicate with my patients before they step into my clinic. How your forms are written, formatted, and presented communicates about your practice and, more importantly, you, for better or worse. It also sets boundaries and expectations for how the relationship will progress.

• Your forms set the stage for your first interaction, and it can help patients feel heard before walking in the door. And, if you ask for adequate information on the intake form, you can go into the first appointment with an idea of what you'd like to talk about.
• Chinese medicine tip: you can learn a bit of diagnostic information from how people fill out their forms, too. Do people fill them out at the last minute or right away? Include a lot of background information or almost no background information? Are they seeing many practitioners for the same concern, or are you the first? How do their answers correspond to your conversation with them? All of these can point to some Chinese medicine information for your diagnostics! You can often pick up on Liver Qi Stagnation just by reading someone's intake form 😂

Tips for writing your forms

• Keep your forms current. Outdated terminology also communicates you are outdated, which can cause patients to lose confidence in your treatments before you even start. Updated forms communicate that you are on top of your business.
  • Using outdated terminology also risks offending and even alienating your patient.
  • If you have a section you no longer need, create a new form - don't just cross it out.
  • You can always have patients sign revised forms! This is particularly easy with electronic forms.
• Ask only relevant information. Our intake forms can get pretty long! As you write your intake form, constantly ask yourself why you are asking for the information.
  • For example, asking about people's height and weight, except in rare circumstances, is irrelevant to patient care in East Asian medicine. Asking for the information can send a message that it matters to their treatment, and it can make people uncomfortable or on guard.
  • Always remember that a patient's records can be subpoenaed, so it is also your responsibility to protect them. Only ask for information necessary to their care, and consider asking for some information in person instead of on a form. A few examples of this include asking about abortions, gender-affirming care, and drug use - but stay aware of evolving dangers for your patients.
  • If you do need to ask something that may make people uncomfortable (or just confused!), you can also consider adding context or explaining why you are requesting information in the form. For example, this is the section I include as an introduction to the food journal in my intake form:

• You communicate your values as a practitioner through your forms, so be intentional about it. Patients will infer what you, as a practitioner, think is important from what you ask (or don't ask!).
  • Asking for pronouns and gender (versus or in addition to sex assigned at birth) conveys you are aware of trans, gender diverse, and queer care. If you are, this is one way to signal it. If you need to ask about sex (such as for insurance), explaining why you request both is helpful.
  • As mentioned above, asking about weight conveys that it is relevant to their care and important to you. If it isn't, then reconsider asking.
  • Keep in mind, how you word questions can convey your opinion on a topic. This can be both positive and negative! One quick example is "history of drug abuse" versus "history of drug use" or "history of drug misuse." You can ask if someone is married, or you could ask what their significant relationships are.
• Make sure your forms are easy to read and fill out. This seems obvious, but isn't always the case!
  • Prioritize electronic forms. It is much easier to have easy-to-read forms when they are electronic because you don't have to worry about fitting things on a page, and it allows people to use assistive devices. (It is also more secure - you have a timestamp for the signature, and likely an IP address too.) If you use EHR software, and you should be, this should be easy.
  • Provide optional areas for people to expand on their answers. Not everyone will use this space, but added context from patients can be unexpectedly helpful sometimes! Plus, it demonstrates that you are interested in their whole story.
  • People won't put effort into a form that is hard to fill out. You've narrowed down what you're asking to the essentials, so you want to make sure people fill it out. Make it easy for them.

A few final thoughts

• Your policies will evolve over time! We often won't know if our policy form is good until it is tested. Once a situation happens that requires you to enforce a policy, you can refer back to the policy you've written and see what it says about the situation. Sometimes, we'll realize that we didn't anticipate the scenario fully or correctly, and our policy may not adequately address the situation; in that case, apply the policy as best as you can and edit your written policies for the future.
• Your policies are not a secret. Post them on your website; at minimum, have your financial policies available for people to reference. This lets your patients review them if they have a question, and it helps if it needs to be enforced. It's hard to argue that they didn't know what the policy was if it was publicly available!
• There is no guarantee that people will fully read your forms before signing them. Many people don't! But that is not your responsibility; your responsibility is to provide clear, thorough forms that protect both you and the patient. Once they sign the form, they agree to abide by the contents, regardless of whether they've read it.

Case Study: Intake Forms

Let's use an example from an optometrist appointment I had in 2024:

I visited a new-to-me optometrist who used a very old form. It used outdated terminology, including some offensive terms, for medical conditions. They requested irrelevant demographic information, such as my marital history - which they must have recognized was unnecessary, because it was crossed out on the paper form. The form used very small font and was (ironically!) difficult to read. The formatting of the form didn't provide space for me to provide additional information on anything I checked in my medical history, and I wasn't able to include information that didn't fit into the outdated categories.

Because the form was so outdated and crowded, I couldn't adequately fill out my medical history and felt uncomfortable including some information. This led to me assuming the office, and possibly the optometrist, had judgements about certain diagnoses, and I didn't feel comfortable disclosing some information. My incomplete form led the optometrist assuming I didn't have any notable health history, which wasn't accurate, and it led to a very poor patient experience.

What's next

In the future, I'll cover tips on writing a few specific policies, sharing example forms, as well as explaining situations where you may need to use your policies. I'm planning on writing entries for Financial Policies and Informed Consent. (Let me know if others would be helpful!) I'll also summarize how to write a defense in the event of a credit card dispute, which shows how your policy can protect you in action.