Pediatric Patient Intake Form Template | Jotform

Patient Registration Form Templates

143 Templates

Patient registration forms are used to register patients for procedures offered at medical facilities. Whether you need to register new patients for your hospital, clinic, health center, or private practice, our free Patient Registration Forms will streamline the registration and onboarding process by seamlessly gathering patient information online. Simply customize any of the free templates below to match your medical facility, and you’ll be registering new patients in no time! Patients will be able to provide their personal information, provide emergency contact numbers, write down their medical histories, attach files, and submit payments all at once. Submissions will be stored safely in your secure Jotform account, easy for you and your staff to access from any device.

Customizing your Patient Registration Form isn’t brain surgery. Using our drag-and-drop Form Builder, you can operate on your form by adding form fields, images, and even your logo without any coding. Jotform also offers hundreds of app integrations designed to streamline your front desk workflow. Integrate your form with a payment gateway to collect registration fees, or with file storage accounts and spreadsheets to keep patient records organized in one place. Win your patients’ trust by keeping their sensitive health information safe — just upgrade to a Silver or Gold plan to make any of our Patient Registration Forms HIPAA compliant. When you’re done customizing, publish it on your website to register patients before their appointments, or have patients fill out the form on a tablet while waiting in the lobby. With our Patient Registration Forms, you’ll register more patients faster, keep better track of your patients, and guarantee a better patient experience overall.

New Patient Enrollment Form

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

Hospital Patient Registration Form

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

Patient Medical History Form

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

Eyelash Extension Consent Form

Eyelash Extension Consent Form

Eyelash extension consent form provides you with all necessary details of your customer such as their contact information, health history, previous lash extension experience with their consent to your terms and conditions.

Coronavirus Intake Form for Massage Therapy

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 Forms

Initial Visit Patient Forms (MDR)

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.

Healthcare Forms

Esthetician Client Intake Form

Esthetician Client Intake Form

Use this Esthetician Client Intake Form to receive information about the client in regards to cosmetic or skin treatment. This form will surely help the technician or clinic on how they will approach the client and offer the appropriate services.

Patient Registration Form Templates

Counseling Intake Form

Counseling Intake Form

The Counseling Intake Form allows for an easier client registration process as it automates gathering information from your clients, reduces paperwork and helps to keep patient records in a systematic way.

Healthcare Forms

Skincare Facial Consent Form

Skincare Facial Consent Form

A skincare facial consent form is a document that allows you to gather information from your clients about their upcoming visit, namely their expectations of the service.

Healthcare Forms

Mental Health Intake Form

Mental Health Intake Form

Perform patient intake online. Collect medical history, supporting documents, and fee payments. Protect patient data with optional HIPAA compliance.

Healthcare 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.

Healthcare Forms

Neuromuscular Massage Therapy Client Intake

Neuromuscular Massage Therapy Client Intake

Neuromuscular Massage Therapy Consent & Client Intake Form

Healthcare Forms

Medical Intake forms

Medical Intake forms

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

Healthcare Forms

Life Coach Intake Form

Life Coach Intake Form

Help an individual achieve his/her professional or personal goals by having them complete this Life Coach Intake Form and then subscribe to life coaching sessions. This form contains all the necessary questions before enrolling in life coach services.

Healthcare Forms

SPEECH/LANGUAGE PATHOLOGY PROGRESS NOTE

SPEECH/LANGUAGE PATHOLOGY PROGRESS NOTE

Here is a simple speech therapy progress notes template made for language therapists and healthcare provider/practitioners. This sample speech therapy progress notes will allow you to gather all the necessary information to keep the progress of your patients. By using this form template, you can also schedule appointments and make bookings for your patients.

Healthcare Forms

Yoni Therapys Vaginal Steam Intake Form

Yoni Therapys Vaginal Steam Intake Form

A vaginal steam intake form is used to document the results of natural vaginal steam treatments.

Healthcare Forms

Body Measurement Form

Body Measurement Form

A body measurement form is a physical evaluation tool used for a variety of functions from clothing design to bodybuilding.

Healthcare Forms

Nutrition Consultation Form

Nutrition Consultation Form

A nutrition consultation form is used by medical practices to record details about consultations with patients and their ongoing nutritional needs.

Telehealth 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 compliance.

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.

Informed Consent Forms

Patient Extensive Intake Form

Patient Extensive Intake Form

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

Medical Application Forms

Patient Registration Form

Patient Registration Form

Before patients can proceed with medication and checkup, they are usually provided with form to register which asks basic patients personal and medical background. This is the form you need.

Healthcare Forms

Clinic Patient Registration Form

Clinic Patient Registration Form

This new patient registration form, or patient intake form, gathers the necessary information that your clinic, practice, or hospital needs to onboard them into your system.

Healthcare 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.

Medical Application Forms