Medical Alert Form Template

Medical Alert FormHi there, what's your name?Please tell us if you have an allergy to anything in the following list:You can add other allergies in the next question.

Nuts

Bee Stings

Eggs

Gluten

Latex

Paracetamol

Are there any other allergies we should know about?Do you have any illnesses or conditions that we should be aware of?Please provide a number for an emergency contactWhat's their name and relation to you?Please enter your email so we can add this to our records.Thanks for completing the form.

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Collect medical alert info with a simple form

If you’re responsible for first aid in your social club, school or office, you need to know how to provide care in an emergency situation. How do you collect this in an organized, simple way? Enter the online form.

With Typeform, you can customize everything

Change text, colors, and even logos to match look and feel of your brand. Then embed forms smoothly onto web and email.

Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.

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Medical alert form FAQs:

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.

A medical alert form allows you to collect important information about your students, employees, or group members. You use it to collect their medical details for emergencies or if they need medical attention. Ask them about allergies, illnesses, and conditions, so that you can provide the care they need or inform medical staff if they are unable to. It’s also a useful way to collect their emergency contact details, so you know who to call to be at their side.

It’s best to capture this information as soon as possible when someone joins your company or team. Make sure to include it in your onboarding processes, or in your new starter pack. It’s important to routinely update the forms too. If a current employee needs to update their information or emergency contact, you can create a complementary medical form and update your database. Using various integrations such as Zapier and Google Sheets makes exporting and logging the data a breeze.