Patient Encounter Form Template

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

What's the name of the patient?What was the reason for their visit?Did you prescribe any medication?What did you prescribe?Did you plan a follow-up appointment?When should this be?If there are any additional files that need to go into the patient's file, upload them here.If there are any comments you want to leave in the patient's file, you can write them down here.All set! {{field:01F7987CD42PGYMZJPAAJ3RVKF}}'s file is updated.

Rated 4.5 out of 600+ reviews on G2.com

Keep patient files updated with just a few clicks

Save time on managing a patient's file after each visit. Let your doctors answer a few quick questions, and the results will be sent to the right file automatically thanks to our smart integrations.

Patient encounter form FAQs:

On the contrary. You can easily tweak this template so it works for the processes in your medical office. It asks one question at a time, so doctors and medical staff won't risk forgetting to mention some vital information.

You can even upload additional files, like scans or test results, without using an extra tool. Plus, it is incredibly easy to use—even if you’re a little rusty on computers.

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.

Patient encounter form not right?

1500+ Templates, 120+ Integrations

Online Order Form Template

Sell products and vouchers online with a custom order form

Learn more

Job Requisition Form Template

Speed up the hiring process with this internal request form for managers

Learn more

Reference Request Form Template

Get the lowdown on candidates with this interactive reference request form

Learn more

monday.com Form Template

Power-up your workflow with our newest integration

Learn more

Lead Generation Form Template

Get more leads—looks great on any device

Learn more

Signup Sheet Template

A fun, friendly way to ask people for information

Learn more

Other categories used by people like you

Order forms Application forms Feedback forms Lead Generation Quizzes Feedback surveys Customer satisfaction surveys File upload forms Evaluation forms Job application forms Marketing surveys Event forms Event surveys

Products

Solutions

Templates

Integrations

Resources & Support

Pricing

Patient Encounter Form Template

Keep patient files updated with just a few clicks

Patient encounter form FAQs:

Updating patient files after each visit is a hassle. How do I make it easier?

Isn’t an additional form going to make things more complicated?

What should I consider before using this healthcare form?

Are all features in this template free?

Make it uniquely yours

Make life easy with integrations

Here's what people say about us

How does it work?

Patient encounter form not right?

Other categories used by people like you