Healthcare Forms
Our collection of online healthcare form templates makes it easier to register new patients and learn about their medical history. The Jotform 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 customizing your own. Additionally, Jotform offers a simple way to update medical history, acquire consent e-signatures, collect bill payments, find new business, and more. Jotform also offers HIPAA compliance features so your healthcare forms stay 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 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 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 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.
COVID 19 Vaccine Pre Registration Form
Pre-register your patients for them to receive a COVID-19 vaccine. Copy this COVID-19 Vaccine Pre-registration Form template to your Jotform account.
COVID Vaccine Consent Form Updated CPESN
COVID-19 Vaccine Consent Form for CPESN Pharmacies to get online appointments, collect patient data and consent to vaccination terms and conditions.
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.
Pharmacy Service Satisfaction Survey
Are they satisfied with your service? Want to find out? Make use of our template to help yourself up!
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.
COVID 19 Liability Waiver
Receive signed liability waivers and e-signatures online with our free COVID-19 Liability Waiver form. Easy to customize and share. No coding is required.
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.
Screening Checklist For Visitors And Employees
Prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees. Ideal for hospitals or other organizations staying open during the crisis.
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.
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.
Passenger Disclosure And Attestation To The United States Of America
Follow CDC requirements with this free passenger attestment form for airlines and aircraft operators. Turns form submissions into PDFs automatically. No coding.
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.
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 electronic signatures. Easy to customize for your practice.
Sample Request Form
A sample request form is a quick and easy way to ask for examples of a product or service from a business.
Mental Health Intake Form
Perform patient intake online. Collect medical history, supporting documents, and fee payments. Protect patient data with optional HIPAA compliance.
Telemedicine Consent Form
Get consenting e-signatures online from your patients. Add terms and conditions without coding. Free HIPAA compliance option for coronavirus responders.
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.
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.
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.
CAHPS® Clinician & Group Survey Version 3.0 (Adult)
Gather feedback from adult patients online. CAHPS® Clinician and Group Survey for healthcare providers. Add supplemental items from AHRQ. No coding required.
CAHPS® Cancer Care Radiation Therapy Survey
Readymade online CAHPS® survey. Collect feedback from cancer patients receiving radiation therapy. Fill out on any device. Upgrade for HIPAA compliance.
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 Surgery Survey
Receive feedback from cancer surgery patients. Official CAHPS® Cancer Care Surgery Survey. Add supplemental items without coding. Fill out on any device.
CAHPS® Clinician & Group Survey Version 3.0 (Child)
Readymade CAHPS® survey for healthcare providers. Easy to share and fill out on any device. Customize with supplemental items provided by AHRQ. No coding.
CAHPS® Health Plan Survey Version Adult Medicaid Survey 5.0
Get patient feedback about their current health plan. Free CAHPS® Health Plan Survey for medical organizations. Easy to share and fill out on any device. No coding.
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® Health Plan Survey Version Child Medicaid Survey 5.0
Get patient feedback about their current health plan. Free CAHPS® Health Plan Survey for medical organizations. Easy to share and fill out on any device. No coding.
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.
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 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 Discharge Summary Form
A hospice discharge summary form is a paper form used by physicians to document medical information about the patient and their recent discharge from the hospital. Get paperless forms today!
Hospice Consent Form
A hospice care consent form is used by medical organizations to enroll patients in hospice care programs. Get the consent you need easily with Jotform!
Hospice Revocation Form
An online hospice revocation form is used by medical practitioners to manage the revocation of their patient’s hospice.
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.
Hospice Sponsorship Form
A hospice sponsorship form is a grant application used by charities to raise funds for hospice care programs. Get your charity fundraising off the ground with a free online Hospice Sponsorship Form.
Hospice Care Checklist
Hospice care is an alternative to traditional medical care that specializes in keeping terminally ill patients comfortable during their last days.
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!
Patient Photo Release Form
Go paperless and immediately store your consent to your records. Use this Patient Photo Release Form template and get your photo release consent from patients immediately!
Release Of Medical Information Form
Disclosure of confidential information requires an authorization or permission from the owner. Use this form so owners can easily sign an authorized consent for the release of their information, whether they wish to release their medical records or other health information.
Covid 19 Questionnaire And Release Form
A Covid-19 questionnaire and release form is used by medical professionals to collect information from patients about the Covid-19 vaccine. No coding!
Permission And Medical Release Form
This is an interactive electronic version of the permission and medical release form used by the Church of Jesus Christ of Latter Day Saints. Note this was not made by the Church of Jesus Christ of Latter Day Saints nor is it endorsed by them. It was made for the individual purposes of the Oak Hills Stake Youth organization.
Precautionary Coronavirus Liability Release Form
This COVID-19 Release Form is crafted specifically for spa industries to gather the consent of their customers to the service terms and precautionary conditions.
Dental Records Release Form
A dental records release form is used by a dentist to collect patient’s medical records from their other doctors. The dental records release form can be customized to fit the way you conduct your business.
Minors COVID 19 Liability Release Waiver
This minors COVID-19 liability release waiver form is used by parents and/or guardians to grant permission for minors to receive the COVID- 19 vaccines. No coding!
Authorization For Release Of Protected Health Information Form
Secure yourself or your company when utilizing your patients or any person's health information in your possession properly. Get this Authorization For Release Of Protected Health Information Form template and start getting the proper consent right away!
Medical Report Form
A medical report form is a document used by medical professionals for documenting a patient’s medical treatment.
Screening Checklist For Visitors And Employees
Prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees. Ideal for hospitals or other organizations staying open during the crisis.
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 Questionnaire
Determine if clients are healthy enough to take part in your activity with a free online Medical Questionnaire. Fill in on any device. Sync with 130+ apps.