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 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.
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.
Immunization Consent Form CPESN Pharmacy
This Immunization Consent Form is for the use of CPESN Pharmacies to detect their patients' immunization and payment preference, schedule appointments, collect patient contact information and medical details with their consent to the immunization terms and conditions.
Simple Prescription Form
A simple prescription form is used in the pharmacy to record the patient’s prescription. Use this free simple prescription form in your practice to track patient prescriptions. No coding!
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!
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.
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.
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.
Beauty Salon COVID 19 Liability Waiver
This COVID-19 Liability Waiver is for Salon businesses to ensure their customers' acknowledgment of the possible risks of a salon service during the pandemic and reminds the measures that can be taken to avoid such risk. This Beauty Salon COVID-19 Liability Waiver provides you with your customers' personal and contact information and their signature to the condition statements. You can customize the template through Jotform's Form Builder, add, remove or change fields, add your own content, change the fonts, colors, background, and either embed it to your website or use it as a standalone form.
Coronavirus Screening Form
Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA compliance option.
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.
Telehealth Consent Form
Get informed consent from patients online. Collect legally binding electronic signatures. Easy to customize for your practice. HIPAA compliance option.
Mental Health Intake Form
Perform patient intake online. Collect medical history, supporting documents, and fee payments. Protect patient data with optional HIPAA compliance.
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.
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.
Physician Referral Form
Refer patients to other physicians and collect referrals online. Easy to customize and embed. Integrate with 100+ apps. HIPAA compliance option. No coding.
Telehealth Counseling Consent Form
Collect consent forms and e-signatures with an online Telehealth Counseling Consent Form. Easy to customize and share. Opt for HIPAA compliance.
Telemedicine E Visit Request Form
Accept requests for e-visits through this free online appointment form. Easy to customize. embed, and share. Integrate with 100+ apps. HIPAA compliance option.
Telehealth Physical Therapy Consent Form
Offering virtual physical therapy appointments? Collect signatures and payments from patients online. Easy to customize and integrate. HIPAA compliance option.
Telehealth Clinical Assessment Form
Assess the medical condition and health status of the patient online by using this Telehealth Clinical Assessment Form. This form template is simple, clean, and easy to use.
Dermatology Telehealth Medical Examination Form
Treat patients remotely. Safely collect medical info online. HIPAA compliance option. Accept photos of skin conditions. 30+ free payment app integrations.
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® 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® 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.
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® 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.
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.
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 Agency Questionnaire Form
Certify a hospice agency by having them complete the Hospice Agency Questionnaire Form and identify if they meet the required standards to get certified. You can add more fields and edit this form by using the Form Builder.
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 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 Incident Reporting (IAU) Form
A Hospice Incident Reporting (IAU) Form is used by medical facilities to report any kind of incident that happens in the facility. Keep your facility on track with Jotform!
Hospice Revocation Form
An online hospice revocation form is used by medical practitioners to manage the revocation of their patient’s hospice.
Hospice Notice Of Election Form
A hospice notice of election form is used by medical organizations to allow patients to make their end-of-life care wishes known.
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.
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.
Health Evaluation Form
If you have an online health service , this forms is suitable for you. Get your patient history, lifestyle and more. Customize it to your needs
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.
Patient Health Questionnaire
If you have an online health service , this forms is suitable for you. Get your patient to fill the form so that you can be able to diagnose them.
Alternative Medicine Patient Intake Form
Do you work for alternative medicine? This alternative medicine disclaimer form is very useful for those herbal medicine practitioners, wellness practitioners, alternative medicine practitioners, holistic medicine practitioners, etc. This holistic health intake form will help you to gather your patients' current diet information, health concerns, lifestyle information, education, physical activity, etc. You can create a HIPAA Compliant holistic nutrition intake form today.
Nutritional Assessment Questionnaire Form
Here is a Nutritional Assessment Questionnaire that is useful for health institutions to learn more about patients' eating habits by asking their blood sugar, fatty acid, inflammation, toxicity, and eating habits.
Health Survey
A health survey is a questionnaire used by medical professionals to collect information about their client’s health.
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.
Veterinary EMR
Do you work for the veterinary group? This veterinary physical exam template is based on the SOAP template for a veterinary physical exam and evaluation. Veterinary treatment sheet template collects information about client's contact details, appointment time, client pet's details and client physical exam findings.
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.
Tracking Forms
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.
Coronavirus Response FormsCoronavirus 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.
Healthcare FormsCOVID-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.
Healthcare 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
Personal Training Consultation Questionnaire
A training questionnaire collecting personal and contact, health, medication, habitual(smoking), occupational, physical information; with areas to fully understand the customer expectation and with package options to select from.
Healthcare Forms
Medical Report Form
A medical report form is a document used by medical professionals for documenting a patient’s medical treatment
Abstract FormsCOVID-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.
Healthcare FormsCoronavirus 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.
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 FormsHealth 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 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
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 FormsCoronavirus Screening Form
Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA compliance option.
Healthcare FormsGym 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.
Healthcare Forms
Physician Release to Return to Work Form
Collect physician releases and e-signatures for your HR department with this online Physician Release to Return to Work Form. Free to use, easy to customize.
Healthcare Forms
Coronavirus Self-Assessment Form
Stay on top of COVID-19 prevention with a free online Coronavirus Self-Assessment Form. Send to patients who may have the virus. Collect data from any device.
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
Coronavirus Intake Form for Massage Therapy
Make sure massage clients are healthy before their spa appointment. Free intake form for massage therapists. Easy to customize, share, and integrate. No coding.
Healthcare FormsInitial 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.
Healthcare 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