Intelligent Medical Intake, Managed for You
Dynamic questionnaires with conditional logic, severity flagging, and treatment routing — built by clinicians, managed by the platform.
Request a Demo- Conditional follow-up questions
- Severity flagging & triage
- Versioned and platform-managed
- Provider review queue included
Have you been diagnosed with Type 2 Diabetes?
This helps us determine the right treatment protocol.
From Product to Prescription Decision
01 — Patient Selects Product
Patient browses your storefront and adds a prescription product to their cart.
02 — Medical Intake
The system serves the right questionnaire for that product’s category — conditional questions, file uploads, consent collection — tailored to the clinical context.
03 — Decision Engine
Responses run through category-specific logic: contraindication screening, severity flagging, treatment eligibility. Hard disqualifications are caught before a provider sees the order.
04 — Provider Review
Flagged responses surface to the provider with priority levels. The provider reviews the full intake, makes the prescription decision, and communicates with the patient if needed.
Questionnaires for Every Treatment Category
Each product category has its own clinically tailored questionnaire. Active today for weight management, dermatology, hair restoration, and peptide therapy — with architecture to support any treatment vertical you grow into.
Weight Management
19-question intake covering BMI calculation, GLP-1 medication history, contraindication screening, mental health assessment, and treatment goal setting. Decision engine routes patients to the right protocol.
Dermatology
Skin type assessment, concern mapping, photo upload, sun exposure evaluation, lifestyle factor screening, and treatment history. Visual severity assessment built in.
Hair Restoration & Peptides
Pattern-based visual selection with image aids, scalp symptom evaluation, family history, and prior treatment assessment. Separate specs for men’s and women’s hair loss.
Conditional Follow-Ups
When a patient answers “yes,” the system surfaces targeted follow-up questions — medication name, dosage, last date taken. Only ask what’s relevant.
Severity Flagging
Every response evaluated for clinical risk. HIGH-priority flags surface automatically to providers. Contraindications trigger hard stops before the order reaches review.
File Attachments
Patients upload lab results, pharmacy records, and treatment photos directly within the questionnaire. Documents stay linked to the session for provider review.
Versioned Templates
Questionnaires are versioned and managed by the platform. Updates go live without code changes. Every response records which version the patient completed.
Visual Questions
Image-based selection for subjective assessments. Patients identify hair loss patterns, skin conditions, or severity levels from visual aids.
Treatment Routing
Category-specific decision engines evaluate responses and route patients to the right treatment protocol. BMI thresholds, contraindication rules, and comorbidity evaluation — automated.
Six Ways to Collect the Right Information
Selection Questions
Single-select and multi-select with optional conditional follow-up fields. “Are you currently taking GLP-1 medication?” → Yes → “Which medication, what dose, when was your last injection?”
Structured Inputs
Numeric and text fields with validation, units, and min/max constraints. Height in feet and inches, weight in pounds, dosage in milligrams.
File Uploads
Patients attach lab results, pharmacy records, medical documents, and treatment photos. PDF, JPG, PNG, and HEIC accepted.
Consent, Free Text & Visual Selection
Multi-checkbox legal acknowledgments before submission. Open-ended responses for treatment goals and medical history. Image-based questions for subjective assessments like hair loss patterns.
Nothing for You to Build
Platform-Managed Templates
Questionnaires are created, validated, and maintained by the platform. New versions go live automatically. You activate a product; the intake comes with it.
Category-Specific Intelligence
Each disease state has its own decision logic. Weight management evaluates BMI and contraindications. Dermatology assesses skin type and treatment history. You don’t configure any of this.
Compliance Built In
Consent collection, response versioning, and audit-ready documentation included in every questionnaire. Responses are stored with the spec version that generated them.
Automatic Product Linking
When you activate a product in your store, the correct questionnaire attaches automatically. Product-specific overrides take precedence over category defaults. No manual mapping required.
Medical Intake: DIY Forms vs. Zaya
Most platforms make you design clinical forms from scratch, hire medical consultants, and build review workflows. Zaya ships them ready.
Legacy Approach
Design intake forms with clinical consultants
Build conditional logic and validation from scratch
Manage form versioning manually
Create separate review workflows for providers
Update forms when regulations or protocols change
With Zaya
Clinically tailored questionnaires for each product category
Conditional follow-ups, severity flagging, and decision engines built in
Versioned templates updated by the platform — no code changes
Provider review queue with prioritized flags included
Questionnaire updates go live automatically when protocols evolve
Frequently Asked Questions
More questions about questionnaires? get in touch.
Questionnaires
Data & Compliance
Request a Demo
Join wellness operators who launched in under an hour. No technical setup. No compliance headaches.