diff --git a/src/app/patient-intake/page.tsx b/src/app/patient-intake/page.tsx
new file mode 100644
index 0000000..c590828
--- /dev/null
+++ b/src/app/patient-intake/page.tsx
@@ -0,0 +1,37 @@
+"use client";
+
+import { ThemeProvider } from "@/providers/themeProvider/ThemeProvider";
+import NavbarLayoutFloatingInline from '@/components/navbar/NavbarLayoutFloatingInline';
+import ContactCenter from '@/components/sections/contact/ContactCenter';
+import FooterBaseCard from '@/components/sections/footer/FooterBaseCard';
+
+export default function PatientIntakePage() {
+  return (
+    <ThemeProvider>
+      <NavbarLayoutFloatingInline
+          navItems={[
+            { name: "Home", id: "/" },
+            { name: "Patient Forms", id: "/patient-intake" },
+            { name: "Appointment", id: "/appointment" },
+          ]}
+          brandName="Forsyth Spinal"
+      />
+      <div className="pt-32 pb-20 px-6 max-w-4xl mx-auto">
+        <h1 className="text-4xl font-bold mb-8">Patient Intake Form</h1>
+        <p className="text-lg mb-6">Please complete our comprehensive patient information form to help us better understand your health history and needs. This form is HIPAA compliant to ensure your privacy.</p>
+        <ContactCenter
+            tag="Secure Intake"
+            title="Patient Information"
+            description="Enter your details to get started with your digital patient file."
+            background={{ variant: "plain" }}
+        />
+      </div>
+      <FooterBaseCard
+        logoText="Forsyth Spinal"
+        columns={[
+            { title: "Navigation", items: [{ label: "Home", href: "/" }, { label: "Patient Forms", href: "/patient-intake" }, { label: "Appointment", href: "/appointment" }] }
+        ]}
+      />
+    </ThemeProvider>
+  );
+}
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