form vs reading

I made up the Confidential Patient Intake Form and actually asked for the opinion of my mother, who is a Registered Nurse. I wanted to make it as clear and concise as possible for patients and loved ones of patients alike so they would be able to fill it out quickly and as calmly as possible.

There's no obvious contrast other than the title of the page which, in boldface, states what the document is and who it's for. The capitalized words/phrases, I don't feel, are contrasting but in theory they are.

I tried to keep a balance in the form by making everything evenly spaced and giving the patient enough line-space to write on. The boxes I put in make it harder to find a balance, because the boxes aren't evenly placed in one line to the other, but the boxes help in efficiency.

I attempted to make everything proportional but I'm not positive if I've succeeded. The entire document reaches from the left margin to the right margin in one way or another, usually by way of line or box.

I repeat the use of the box- for the better use of the patient. I also used lines after the prompt for the information on the patient- this allows them to write in the correct information in the correct area. Since the document is very simple and color would be slightly inappropriate, I thought it best that the design be completely straightforward and efficient.

I feel that this design has harmony. I wanted it to be very easy to fill out and easy to work with in that if a distressed patient or loved one of a patient were to be asked to fill out the form, they could easily be able to fill it out, even in a frantic attitude. The form is easy to read, simple to understand and gives enough room for the information to be put in.

The document has movement in that it's all placed against the left margin (except for the Date) and allows the patient to read from left to right, rather than jumping all over the page.

I don't know if this document has unity, and it definitely doesn't exactly scream for attention, but I didn't feel that was the point. If something has unity, I assume everything works together, and your eye is able to move fluently from one piece of information to the other, and I feel that's what this form does, in its most basic way. It's not meant to be a flashy or warm/inviting form, because it's not meant to be something that other people (aside from an insurance company/the employees of the hospital) will be looking at.