New Patient Form Template

Try it
Full Screen Preview

Get started — it's free

Let’s take care of your patient administration

Spend less time on creating new patient files by hand, and more time on your patients. Our integrations with Google Sheets, Office 365 and Dropbox help you automate a lot of the busywork that comes with the job.

New patient form FAQs:

1. How does this new patient form template save us time?

You’ll still have to put in the data yourself, but that’s about it. Our smart integrations take care of things like creating follow-up tasks, generating patient files and notifying relevant doctors of anything they need to know about the new patient.

When you hit the submit button, things get set in motion automatically. No more copy-pasting data into spreadsheets, much more time spent with patients.

2. How can I make this new patient form template fit our needs?

We’ve given you some inspiration in the template, but don't stop there—you can completely customize it from head to toe. It’s even possible to upload files directly into the form.

Tracking progress and need a benchmark? Add a scale question to see how the treatment goes. Start playing around with the possibilities to see how you can transform your patient intakes.

3. What should I consider before using this healthcare form?

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

  1. 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. Do this by filling out this typeform, or contacting your Typeform account manager.

  1. 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

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

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

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro
Collect 18% more data with Typeform compared with our two main competitors in the market
How does it work

How does it work?

Make a stylish form in minutes with our drag-and-drop builder.

Choose from different question types: multiple choice, rating, opinion scale, free-form text, and more.

Take respondents down different paths based on their answers.

New patient form not right?

400+ Templates, 120+ Integrations

  1. All templates
  2. Forms
  3. Healthcare forms
  4. New Patient Form Template