Pediatric Patient Intake Form Template | JotForm

Patient Registration Form Templates

92 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

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)

Get more information about your patient medical history with this simple and easy to use form

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.

Neuromuscular Massage Therapy Client Intake

Neuromuscular Massage Therapy Client Intake

Neuromuscular Massage Therapy Consent & Client Intake Form

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

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

Body Measurement Form

Body Measurement Form

Do you want to be a good-looking person? This body measurement form is the best for you. It's a great looking body measurement template with matching visual guide on the left side for measurements. This template for body measurements contains measurements of different parts of your body.

Healthcare Forms

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

Patient Extensive Intake Form

Patient Extensive Intake Form

An extensive Patient Intake Form.

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

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.

Healthcare Forms

Skincare Facial Consent Form

Skincare Facial Consent Form

Facial Consent form providing all necessary information of your patients such as their personal and contact information, health and skin details with their consent to terms and conditions.

Healthcare Forms

Peritoneal Dialysis Record Form

Peritoneal Dialysis Record Form

For healthcare centers, use this dialysis form to provide patients a way to securely submit their daily treatment record to their attending physician online. This peritoneal dialysis record sheet allows clients to set up for manual or machine modality. Use this treatment record form to communicate with your patients and monitor their health status and progress with their self or at home treatment. This peritoneal dialysis log sheet can be integrated with a Google spreadsheet which can be shared with your medical team at the center.

Patient Registration Form Templates

Coronavirus Suspected Patient Intake Form

Coronavirus Suspected Patient Intake Form

Patients with suspected COVID-19 symptoms can report them online through this free intake form. Easy to customize. HIPAA compliance option. No coding required.

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

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

New Pediatric Patient Registration Form

New Pediatric Patient Registration Form

This new patient registration form will help every neonatologist and pediatrician that needs to evaluate children development or help, with every important details in order to keep track of their development and improvement of their patient.

Healthcare Forms

New Patient Registration

New Patient Registration

Do you want to collect important information like name, email and other information from your patients on their first appointment for record keeping? You've come to the right form!

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!

Insurance Forms

Nutrition Consultation Form

Nutrition Consultation Form

Nutrition Consultation Form is helping dietitians to collect client intakes and improve patients' nutrition and eating habits.

Telehealth Forms