Employee Medical Form Template

✓ No credit card required
✓ No time limit on Free plan

Employee Medical FormFirstly, what's your name?and your company email address, {{field:2305caa7-5d48-4f7a-87c5-73789b5f51e3}}?What's your home address?Who's your emergency contact?Please include their relationship to you in brackets, e.g. (SPOUSE)and what's their phone number?If you've got any allergies, list them hereAre you on any medication? If so, please list them hereDo you suffer from any of these?

Arthritis

Chronic respiratory problems

Heart disease

Diabetes

High blood pressure

You're all set. Thanks a lot for updating us.

Rated 4.5 out of 600+ reviews on G2.com

Manage data in a couple of clicks

Make gathering details quick and easy with this employee medical form. Customize it, set up integrations, hit “share” and watch your data organize automatically.

Employee medical form FAQs:

An online form streamlines the information collection process in two ways. First, it plots the data into fields, meaning there’s no manual cutting and pasting to be done. Simply export your responses and you’ve got an organized spreadsheet. Second, it does the hard work for you when it comes to collection. No back-and-forth emails or digging around for stray pieces of info—gather everything at once in one single step.

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.

Make it uniquely yours

Customize to your heart's content: backgrounds, Google fonts, colors, buttons, and more.

Choose from thousands of beautiful images, videos, and icons. Or use your own.

Create beautiful forms with zero coding required.

Get started — it's free

Make life easy with integrations

Google Sheets

Salesforce

Slack

Google Analytics

Zapier

HubSpot

Here's what people say about us

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

87% of users reported higher completion rates after switching to Typeform

How does it work?

Make a stylish form in minutes with our intuitive builder.

Choose from different question types: Multiple Choice, Rating, Opinion Scales, and more.

Take respondents down different paths based on their answers.

Employee medical form not right?

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Employee Medical Form Template

Manage data in a couple of clicks

Employee medical form FAQs:

How do I manage responses from my employee medical form?

Why use an online form to collect employee medical details?

What should I consider before using this healthcare form?

Make it uniquely yours

Make life easy with integrations

Here's what people say about us

How does it work?

Employee medical form not right?

Other categories used by people like you