Telehealth Forms

7 Templates

Telehealth forms help healthcare practices schedule virtual appointments with patients and collect medical records, informed consent, fee payments, and other important health data online. Whether you’re part of a doctor’s office, teletherapy practice, or dermatology center, you can use Jotform’s free telemedicine forms to securely gather important patient information and diagnose conditions through your website. Simply choose a readymade form template from the list below, customize it to match your practice by adding your logo and updating form fields, then embed it in your website or share it via email to start collecting info online.

To help keep sensitive health data protected, be sure to sign up for HIPAA compliance features by signing a Business Associate Agreement (BAA). You can even automatically send form submissions to other platforms you’re already using, like Google Calendar, Dropbox, Google Drive, and more. Jotform offers an all-in-one solution to collect important info from your patients online — so take your telemedicine practice to the next level with our free Telehealth Forms.

Sample Request Form

A sample request form is a quick and easy way to ask for examples of a product or service from a business.

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Virtual Care Appointment Form

Easy appointment scheduling for e-visits. Great for telemedicine! HIPAA compliance option. Embed anywhere. Integrate with 100+ apps. No coding required.

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Telemedicine Appointment Form

Let patients request virtual appointments online. Add a calendar field without coding. HIPAA compliance features. Perfect for telemedicine providers.

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Telemedicine E Visit Request Form

Accept requests for e-visits through this free online appointment form. Easy to customize. embed, and share. Integrate with 100+ apps. HIPAA compliance features.

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New Patient Appointment Form

Schedule appointments online for new patients. Easy to customize and embed. Sync to Google Calendar, Zoom, and 100+ apps. HIPAA friendly features option. No coding.

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Virtual Clinic Appointment

Easy appointment scheduling for your virtual clinic. Free online booking form. Easy to customize, embed, and integrate. HIPAA compliance option. No coding.

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These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.