- Form Templates
- Healthcare Forms
Registering new patients or learning about previous medical history are some of the processes made easier with our collection of online healthcare form templates. Our form builder provides Healthcare practitioners with an array of widgets, applications, and themes to enhance patient engagement. Enabling better communication between patient and provider, to better understand patients and their needs.
Get started by choosing one of our healthcare templates or start your customizing your own form. Additionally, Jotform offers the simple way to update medical history, acquire consent signatures, collect bill payments, find new business, and more. Plus, Jotform offers HIPAA compliant forms, so your paper healthcare forms are secure.
View our full collection of online healthcare form templates below.
COVID 19 Vaccine Registration Form
Collect COVID-19 vaccine registrations online. Fill out on any device. Easy to customize, share, and embed. Convert submissions to PDFs instantly. HIPAA option.
COVID 19 Vaccine Consent Form
Collect signed COVID-19 vaccine consent forms online. Easy to customize, share, and fill out on any device. Upgrade for HIPAA compliance. Convert to PDFs instantly.
COVID 19 Vaccine Survey
Get to know how people feel about the new COVID-19 vaccine with a custom online survey. Easy to personalize, embed, and share. Option for HIPAA compliance.
COVID 19 Vaccine Declination Form
Document the person's refusal from receiving the COVID-19 vaccination. Copy this COVID-19 Vaccination Declination Form to your Jotform account.
COVID 19 Vaccine Appointment Form
A COVID-19 vaccine appointment form is used by medical practices to schedule COVID-19 vaccine appointments. It’s been a long time coming, and patients are anxious to get their vaccines administered as quickly as possible — so make the scheduling process as seamless as possible with Jotform’s free online COVID-19 Vaccine Appointment Form. Just customize the form to match your practice, opt for HIPAA compliance to keep patient data secure, embed the form in your website or share it with a link, and start collecting bookings online. Use Jotform’s drag-and-drop Form Builder to quickly add your appointment slots to the calendar widget, which automatically makes bookings unavailable once they have been booked by a previous patient — a great way to avoid double-booking! You can also upload your logo, include extra questions, and further personalize the design — or sync submissions to third-party apps like Google Calendar, Google Sheets, and Slack with our 100+ free form integrations! Improve the way you book appointments for your practice with Jotform’s online COVID-19 Vaccine Appointment Form.
Moderna COVID 19 Vaccine Appointment Scheduling And Consent Form CPESN
This vaccine appointment form is for the use of CPESN facilities to collect online vaccination appointments for the Moderna Vaccine by asking their patients to provide their personal and contact information, current health status and insurance information, vaccine details and consent to each term and condition through e-signature.
COVID 19 Vaccine Pre Screening Form
The COVID-19 Vaccine Pre-screening Form is used by medical practitioners and pharmacists to screen potential COVID-19 vaccine recipients to determine whether there is any reason the patient should not receive the COVID-19 vaccine. Once screened, the individuals may be sent for further evaluation if they do not meet the necessary conditions.
Moderna COVID 19 Vaccine Consent Form CPESN
This COVID-19 vaccine consent form is for the use of CPESN facilities to collect patient consent regarding the Moderna Vaccine by asking vaccine recipients their personal and contact information, vaccine screening questions, vaccine manufacturer information and vaccine details, with their consent to the detailed terms and conditions regarding the vaccination process.
COVID 19 Liability Release Waiver
Start collecting your participants' liability release waiver for this pandemic using this COVID-19 Liability Release Waiver Template. Just connect your device to the internet and load your form and start collecting your liability release waiver. Get this here in Jotform!
COVID 19 Vaccine Registration Form
Collect COVID-19 vaccine registrations online. Fill out on any device. Easy to customize, share, and embed. Convert submissions to PDFs instantly. HIPAA option.
Coronavirus Self Declaration Form
Employees can complete this form online and report any COVID-19 symptoms they may have. No coding is required. HIPAA compliance option.
Employee COVID 19 Self Screening Questionnaire
Employee COVID-19 Self Screening Questionnaire tracks the health condition of your employee and helps to take the precautionary measures to prevent the spreading of coronavirus in the workspace. Fully customizable with no coding.
COVID 19 Vaccine Consent Form
Collect signed COVID-19 vaccine consent forms online. Easy to customize, share, and fill out on any device. Upgrade for HIPAA compliance. Convert to PDFs instantly.
Coronavirus Case Report Template
People can report suspected cases of COVID-19 in their workplace or community. Easy to customize, integrate, and share online. No coding required.
Health Declaration Form
Sharing this Health Declaration Form that is intended to be used by many businesses is based on the Health Declaration Forms used by the Philippine House of Representatives and Malacañan Palace in relation to the COVID19 response. You can choose the option to encrypt the responses with Jotform to ensure the privacy of responses from our customers. Together, #WeRecoverAsOne!
Negative COVID 19 Test Reporting Form
Receive submissions for COVID-19 test reports from your staff for your company or organization online. Use this Negative COVID-19 Test Reporting Form template and make your receiving process simple and manageable.
New Patient Enrollment Form
New Patient Enrollment Form which personal information, contact information, emergency contact people area and medical history information are provided; allowing you to have an easier and faster registration process.
Coronavirus Screening Form
Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA compliance option.
Telehealth Consent Form
Get informed consent from patients online. Collect legally binding electronic signatures. Easy to customize for your practice. HIPAA compliance option.
Telemedicine Consent Form
Get consenting e-signatures online from your patients. Add terms and conditions without coding. Free HIPAA compliance option for coronavirus responders.
Mental Health Intake Form
Perform patient intake online. Collect medical history, supporting documents, and fee payments. Protect patient data with optional HIPAA compliance.
HIPAA Medical History Form
HIPAA Medical History Form allows gathering patient's contact details with their current symptoms, medications, allergies, drug use, and family medical history that allows for a better healthcare service and management process.
Teletherapy Consent Form
Collect informed patient consent and e-signatures online with a free Teletherapy Consent Form. Great for remote medical services. Get HIPAA compliance today.
Nutrition Consultation Form
A nutrition consultation form is used by medical practices to record details about consultations with patients and their ongoing nutritional needs.
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.
Reiki Intake Form
Collect client contact info and e-signatures online with a free Reiki Intake Form. Easy to customize, embed, and fill out on any device. Sync with 100+ apps.
CAHPS® Child Hospital Survey
Ready-to-use CAHPS® survey for hospitals. Share with your patients’ parents to fill out on any device. Upgrade to protect data with HIPAA compliance.
CAHPS® Cancer Care Drug Therapy Survey
Ready-to-use CAHPS® survey. Gather feedback from cancer patients regarding their drug therapy treatments. Fill out on any device. Upgrade for HIPAA compliance.
CAHPS® Cancer Care Surgery Survey
Receive feedback from cancer surgery patients. Official CAHPS® Cancer Care Surgery Survey. Add supplemental items without coding. Fill out on any device.
Patient Supplies Order Form
Keeping a clear and organized medical order in the healthcare business is important because it saves time and enhances the efficiency of their medical order. This patient supplies order form is mostly used by medical staff and hospitals. The objective of this form is to assist and help medical staff for keeping the records of used supplies by patients. The form will need information such as patient information and medical supply information. The costs incurred for each service and the materials are also needed to complete the form.
COVID 19 Daily Health Screening Form
Receive coronavirus screening forms online. Great for students, clients, employees, and more. Easy to customize, embed, and share. Fill out on any device.
Hospice Nursing Assessment Form
Determine the type of care needed by the patient by using this Hospice Nursing Assessment Form. This form will help the nurse analyze and classify the patient's current health condition.
Palliative Care Assessment Form
Classify the type of care that the patient with severe illness is needed by using this Palliative Care Assessment Form. This form is simple yet contains all necessary health questions to diagnose the patient correctly.
Hospice Transfer Form
Transfer patients from one hospice care provider to another by using this Hospice Transfer Form. This form template can be embedded on any webpage and can be opened on any mobile device.
Hospice Volunteer Application Form
Accept Hospice Volunteer applications online using this Hospice Volunteer application form! Simply copy this form to your Jotform account and immediately publish it to your website!
Hospice Referral Form
Use this Hospice Referral Form when referring a qualified patient to hospice care. This form contains all necessary fields that will make a smooth transition from one institution to another.
Hospice Patient Satisfaction Survey
Hospice patient satisfaction surveys are inquiries used by medical providers to seek feedback from patients about their hospice care. Collect patient feedback with a free online Hospice Patient Satisfaction Survey.
Hospice Care Checklist
Hospice care is an alternative to traditional medical care that specializes in keeping terminally ill patients comfortable during their last days.
Medical Report Form
A medical report form is a document used by medical professionals for documenting a patient’s medical treatment
Patient Feedback Form
A patient feedback form is a survey with questions that allows medical doctors to gather feedback from patients regarding their overall experience with the clinic.
Coronavirus Case Report Template
People can report suspected cases of COVID-19 in their workplace or community. Easy to customize, integrate, and share online. No coding required.
Patient Medical History Form
The template is used by patients to register medical history through providing their personal information, weight, allergies, illnesses, operations, healthy habits, unhealthy habits. You can integrate the data to your own systems.
Gym Health Questionnaire Form
A gym health questionnaire is a health form that is used by gym instructors to track the health and fitness of their clients.
Skin Care Consultation Form
If you make a skin care consultation you can use this skin care consultation form to make an appointment for follow up check up. This facial consultation form template provides to collect contact information, skin information such as skin care goals, skin care challenges, skin care products that are used by the client, health information such as illnesses, allergies. Also, this skin consultation form template contains your policies and allows your policies to be accepted by your customers. You can collect your clients' signatures with this skin care client consultation form.
Contact Tracing Form
Reduce the spread of coronavirus with a free online Contact Tracing Form. Ideal for hospitals, medical organizations, and nonprofits. Collect data on any device.
Initial Visit Patient Forms (MDR)
An initial visit patient form is used by medical practitioners to collect information from patients as they arrive at their practice's office for an initial visit.
Medical Employment Information Form
Here is an Employee Medical History Form that can be used to create an employee medical information database which provides employee contact information along with emergency contact information and medical insurance details.
Other Healthcare Forms
Medical History Form
A medical history form is a questionnaire used by health care providers to collect information about the patient’s medical history during a medical or physical examination.
Health Tracking Forms
Online Doctor Appointment Form
The template simplifies the process of scheduling doctors appointment with new and recurring patients through collecting relevant information of the patient and appointment. You can create a HIPAA compliant Appointment Form today
Healthcare Forms
New Patient Enrollment Form
New Patient Enrollment Form which personal information, contact information, emergency contact people area and medical history information are provided; allowing you to have an easier and faster registration process.
Healthcare Forms
Patient Feedback Form
A patient feedback form is a survey with questions that allows medical doctors to gather feedback from patients regarding their overall experience with the clinic.
Healthcare Forms
Hospital Patient Registration Form
Through the Hospital Patient Registration Form, you can collect all necessary data of your patients' health related information as their name, birthday, health history, family doctor, emergency contact information and more.
Healthcare Forms
Health Declaration Form
Sharing this Health Declaration Form that is intended to be used by many businesses is based on the Health Declaration Forms used by the Philippine House of Representatives and Malacañan Palace in relation to the COVID19 response. You can choose the option to encrypt the responses with Jotform to ensure the privacy of responses from our customers. Together, #WeRecoverAsOne!
Healthcare Forms
Hospital Discharge Form
This hospital discharge form is suitable for hospitals and clinics worldwide. The staff of hospitals can use this form to ensure all requirements are meant before a patient is discharged. The form is very detailed and contains every essential information needed. However, if this sample hospital discharge form does not contain one or more fields you needed, you do need to worry. You can easily edit the sample discharge form to ensure that it meets your hospital's format. And editing this hospital discharge form is very simple. You do not need coding skills. Why not start using this form today to capture the information you need before discharging patients.
Healthcare Forms
Patient Medical History Form
The template is used by patients to register medical history through providing their personal information, weight, allergies, illnesses, operations, healthy habits, unhealthy habits. You can integrate the data to your own systems.
Healthcare Forms
Massage Therapy Client Intake
Never thought you needed therapy? You can sign up for massage therapy with massage intake form template and you can create a HIPAA Compliant. Also, client intake form massage is used by Chiropractors. Massage therapy intake contains different questions about personal information, contact information, history of pathology and the client's symptoms.
Healthcare Forms
Patient Supplies Order Form
Keeping a clear and organized medical order in the healthcare business is important because it saves time and enhances the efficiency of their medical order. This patient supplies order form is mostly used by medical staff and hospitals. The objective of this form is to assist and help medical staff for keeping the records of used supplies by patients. The form will need information such as patient information and medical supply information. The costs incurred for each service and the materials are also needed to complete the form.
Hospice Forms
Psychiatric Evaluation Form
Use this neat and well-detailed psychiatric evaluation form to collect information about your psychiatric patients. This psychiatric evaluation form template can be customized to collect family history, list out symptoms and fields to input your examinations. Through Jotform your psychiatric evaluation template has access to an assortment of widgets and apps to make collecting the evaluation information easier. Get started with this our psychiatric evaluation form sample for a head start or create your own blank psychiatric evaluation form. Create a HIPAA compliant psychiatric evaluation form template today!
Healthcare Forms
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Disclaimer
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.
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