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Medical Application Forms

114 Templates

Looking for a better way to gather medical staff application forms, reimbursement application forms, or health insurance application forms? Whether you’re managing a hospital or private practice, take your Medical Application Forms online with Jotform! Simply choose a form template below to rid yourself of messy paperwork and improve your intake process. Start by embedding your custom medical application form on your website, and watch as submissions are securely sent to your Jotform account — easy to view and manage on any device.

If you’d like to customize the look of your chosen medical form, don’t worry — Jotform Form Builder makes it easy to get the exact look you want. Add your company logo, change fonts and colors, or add a useful widget or integration to make your application process even more efficient. Why not integrate with a secure payment gateway like Stripe or PayPal to securely accept application fees online? Be sure to keep your data secure with HIPAA compliance features. — this is especially important for sensitive health information submitted for medical card applications, medical reimbursement applications, and medical insurance applications. Streamline your application process with a free, online Medical Application Form today!

Form Templates: Online Doctor Appointment Form

Online Doctor Appointment Form

An online doctor appointment form is used by medical practices to schedule medical appointments through the practice website.

Appointment Forms
Form Templates: Coronavirus Screening Form

Coronavirus Screening Form

Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA friendly features.

Coronavirus Response Forms
Form Templates: Blood Donation Form

Blood Donation Form

This blood donation form lets you provide a health clinic, hospital, or blood bank with the information they need to add you to their subscriber link for blood donors. Fully customizable and free.

Medical Application Forms
Form Templates: Intake Form For Care Providers

Intake Form For Care Providers

Use this detailed intake form for your healthcare/rehabilitation facility, capture patient information with an agreement between you and the patient.

Medical Application Forms
Form Templates: Organ Donation Registration Form

Organ Donation Registration Form

Signing up in a donor registry can be a daunting task. Help the donors to become a registrant by using this simple Organ Donation Registration Form which is very easy to use.

Medical Application Forms
Form Templates: Teletherapy Consent Form

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.

Telehealth Forms
HIPAA Medical History Form

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.

Medical Surveys & Questionnaires
Medical Intake Form

Medical Intake Form

A Medical Intake Form is used by health care providers to collect patient medical history, past surgeries, genetics, and symptoms.

Patient Registration Form Templates
Doctor Referral Form

Doctor Referral Form

Efficiently write your Doctor Referral form by directly providing the information in the form. Send your referrals instantly using this Doctor Referral Form.

Healthcare Forms
COVID 19 Client Health Questionnaire

COVID 19 Client Health Questionnaire

The COVID-19 Client Health Questionnaire is a document that physicians and vaccine experts use to collect information from their clients. Just customize this template without coding!

Healthcare Forms
Medical Insurance Application

Medical Insurance Application

A medical insurance application form is used to collect the necessary information to determine whether an individual is eligible for health insurance coverage.

Medical Application Forms
Patient Intake Form

Patient Intake Form

Register new patients for your practice with a free online Patient Intake Form. Great for telemedicine or telehealth. Option for HIPAA friendly features.

Patient Registration Form Templates
Reiki Intake Form

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.

Telehealth Forms
Dietitian Patient Questionnaire

Dietitian Patient Questionnaire

Here is a Dietitian Patient Questionnaire that allows for new patient enrollment through collecting their personal and contact information with a detailed medical history and nutrition habits.

Patient Registration Form Templates
Patient Extensive Intake Form

Patient Extensive Intake Form

A patient extensive intake form is used by nursing or medical professionals to document patient information.

Healthcare Forms
COVID 19 Testing Registration And Consent Form

COVID 19 Testing Registration And Consent Form

A COVID-19 testing registration and consent form is an online registration system for people interested in testing for the COVID-19 vaccine.

Healthcare Forms
Medical Insurance Verification Form Template

Medical Insurance Verification Form Template

Verify insurance information from patients. Easy to customize and embed. Integrate with 80+ apps. Perfect for healthcare organizations. No coding required. Try now for free!

Patient Registration Form Templates
Medical Staff Application Form

Medical Staff Application Form

A handy form used as an application form for those who are looking for a medial staff. This gathers all the information needed to make sure they will hire the perfect fit for the job. It has personal details section, criminal background check, certifications and language fluency options, position and availability section, with fields where they can put their past experiences and personal references, and terms and condition section with signature field that will serve as a contract for both parties.

Medical Application Forms
Pediatric Patient Intake Form

Pediatric Patient Intake Form

Here's a pediatric intake form to evaluate children's health needs. If you are a pediatrician, you can use this pediatric history template to connect with the children's parents or guardians quickly and easily, get valid answers about their child's health and a lot more information. Use this pediatric health history form template to provide comprehensive health care and a complete understanding of the patient’s physical, mental and emotional condition and history.

Patient Registration Form Templates
Chiropractic Intake Form

Chiropractic Intake Form

Check the needs of the patient by using this Chiropractic Intake Form. This will serve as a health record of the patient where the chiropractors can base on how they will proceed with the treatment.

Medical Application Forms
Prescription Refill Form Template

Prescription Refill Form Template

Prescribe medication refill online by using this Prescription Refill Form Template. This form template can be easily accessed in any device like smart phones, tablets, and laptops.

Healthcare Forms
Patient Waiting List

Patient Waiting List

Use this free Patient Waiting List template to sign up potential patients for their examinations and treatment.

Medical Application Forms
Waxing Consultation Form

Waxing Consultation Form

A waxing consultation form is a form used by estheticians for collecting information regarding the needs of a customer that plans to get a wax treatment. Use this Waxing Consultation Form without coding!

Salon Forms
Patient Encounter Form Template

Patient Encounter Form Template

Monitor office visits with this free Patient Encounter Form. Easy to customize and fill out from any device. HIPAA compliance features. No coding required.

Medical Application Forms