Patient Enrollment Forms

12 Templates

Get new patients enrolled in your practice fast with online Patient Enrollment Forms. Whether you’re a doctor, dentist, therapist, or other medical professional, you can gather important patient information like contact details, e-signatures, file uploads, and payments securely online. All responses are stored in your Jotform account and protected with a 256-bit SSL connection, PCI compliance, and optional HIPAA compliance.

Make changes to your chosen Patient Enrollment Form template using our drag-and-drop builder. With no coding required you can upload your logo, add or remove form fields, change the form’s fonts and colors, and add powerful widgets and integrations — such as 30+ payment processors for gathering enrollment fees online. Speed up your intake process with online Patient Enrollment Forms from Jotform.

Patient Information

A patient information form is used by medical practices to collect information from patients.

Information Request Forms
Preview

Patient Discharge Form

A patient discharge form is a form used by medical facilities to communicate vital information of a patient to the next healthcare provider.

Patient Enrollment Forms
Preview

MyPractice Enrollment Form

NZ General Practice Enrollment Form with Information statement

Healthcare Forms
Preview

Psychology Intake Form

A Psychology Intake Form is used by medical professionals to assess new patients to a mental health clinic. Add your logo and update the background of the form to fit your brand without coding!

Patient Enrollment Forms
Preview

Remedial Massage Intake Form

A remedial massage intake form is a form used to register clients for a remedial massage session.

Healthcare Forms
Preview

Blank FHO Enrolment Form

For Ontario family physicians enroling patients into their Family Health Organizations.

Enrollment
Preview

Medicare Claim Form Template

A Medicare claim form is a document used by healthcare providers to bill the government insurance program Medicare.

Patient Enrollment Forms
Preview

Adult New Patient Enrollment Form

Adult New Patient Enrollment Form is useful when you are running a medical clinic for easily collect information from patients and enroll them in your practice.

Healthcare Forms
Preview

Monkeypox Investigation Form

A Monkeypox Case Investigation Form is a document used by public health officials in the investigation of a monkeypox case.

Patient Enrollment Forms
Preview

Eye Exam Form Template

The Eye Exam Form Template is a document created by doctors and medical professionals to record the results of eye examinations. Easy to use. No coding. No messy papers.

Medical Surveys & Questionnaires
Preview

Off Site Patient Enrollment Form

Off-site medical form for Lume Wellness

Consent Forms
Preview