New patient form template

Register new patients in a heartbeatWhat's the patient's first name?And their last name?What's {{field:01F798PC0MDCT69XMB11J9C6QT}}'s date of birth?What's their insurance number?Which doctor will be treating them?

Dr. Faulkner, Dr. Winter, Dr. Collier, Dr. Hart

What will {{field:01F798PC0MDCT69XMB11J9C6QT}} be treated for?Thank you! A patient file for {{field:01F798PC0MDCT69XMB11J9C6QT}} has been created.

Collect up to 3.5x more data with Typeform

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.

With Typeform, you can customize everything

Change text, colors, and even logos to match the 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.

Stay efficient by connecting forms to your workflow. Typeform integrates with 300+ tools including Slack, Zapier, and HubSpot.

New patient form FAQs:

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.

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.