What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.

At JotForm, we want to make sure that you’re getting the online form builder help that you need. Our friendly customer support team is available 24/7.

We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you’d like help immediately, feel free to search for a similar question, or submit your question or concern.

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    Creating a Hospital Diagnosis Form

    Asked by Bill Louth  on January 27, 2015 at 08:52 AM

    We're an IT firm.  One of our customers is thinking of using an online form tool to create and populate a medical report.


    It starts with a doctor entering patient symptoms by checking different boxes; numbness, tingling, pain, etc.

    Checking boxes should add boilerplate legalese type text into the body of the final report.


    Summary of the process:

    Step 1) Enter patient information, check boxes for symptoms, add comments, etc.

    Step 2) Report is generated based on the above selections

    Step 3) Report is emailed


    Can your product do that?

    And do you have a phone number, even a paid service, to help us create the form?



    330-493-5600 x4122


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    JotForm Support

    Answered by Jan on January 27, 2015 at 09:54 AM

    Hi there,

    Yes, JotForm can do all of that. 

    You can enter information in the input field, add comments using the text area and use check boxes for checklists.

    Once the user submits the form, it will create a report based on the form fields and submission answers.

    You can create a notifier so if someone fills up the form, you will receive it via email.

    Please check this demo form.

    We don't offer phone support. The best way to reach us is through this Support Forum where you can post questions and we will be gladly answering them with the best of our knowledge. Thank you for understanding.

    Hope this helps. Thank you.


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    Answered by rodayna  on October 27, 2015 at 05:37 AM

    could you please help me with an application form about a patient all information to be described in related to invitation letter comes from a foreign hospital for treating and send it to the hospital so they can know that the patient got the invitation letter
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    JotForm Support

    Answered by Jan on October 27, 2015 at 10:41 AM


    This is an old thread. Let me create a new thread for your inquiry. Here's the URL: http://www.jotform.com/answers/690881

    Thank you.

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    Answered by Kate Evans  on March 20, 2017 at 09:47 AM

    It takes us immense pleasure to announce the conference that 26th International Conference on Clinical Diabetes which is going to be held during December 14-15, 2017 at Rome, Italy