Confidential Patient Information Form
A Confidential Patient Information Form is a form used by healthcare providers to protect the identity and private information of patients. With a Confidential Patient Information Form, you can store patient information in a secure, encrypted database! Just collect the information you need from patients through a Confidential Patient Information Form — then store it on your Jotform account, share it with other users, or download it to PDF. Encryption and advanced security will keep your private information safe.
Just customize the form and make it your own with your logo, background image, or extra form fields. Want to store the responses you collect with this form? Use Jotform’s free integrations to automatically send patient information to your CRM accounts, such as HubSpot or Salesforce (also available on Salesforce AppExchange) — or save it to your storage accounts, such as Google Drive or Dropbox. Even if you’d like to collect payments, you can use Jotform’s payment processors like Square, Stripe, or PayPal — just customize the form with the payment information you need. If you’d like to accept credit card payments online, just integrate with a trusted payment processor like Square, Stripe, or PayPal. Make the most of your medical practice with a free Confidential Patient Information Form — store patient information without worrying about who’s accessing it.
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.
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.
