A patient intake form is used to collect medical history, contact details, and other important health information from new patients signing up at a medical practice. Healthcare organizations switching to telemedicine can use this online Patient Intake Form to seamlessly register new patients for their practices remotely. To get started, simply customize the template design to match your practice, embed the form in your website or send it to new patients, and start collecting important medical information securely through Jotform.
In addition to adding your company logo and questions relevant to your practice, you can sync your Patient Intake Form submissions to 100+ apps you’re already using like Google Sheets, Dropbox, Box, and more. Be sure to upgrade your account in order to help protect patient data with HIPAA compliance features. Collect and protect sensitive health data with a free online Patient Intake Form.