Medical Application Forms

52 Templates

Looking for a better way to gather medical staff application forms, reimbursement application forms, or health insurance application forms? Whether you’re managing a hospital or private practice, take your Medical Application Forms online with JotForm! Simply choose a form template below to rid yourself of messy paperwork and improve your intake process. Start by embedding your custom medical application form on your website, and watch as submissions are securely sent to your JotForm account — easy to view and manage on any device.

If you’d like to customize the look of your chosen medical form, don’t worry — JotForm Form Builder makes it easy to get the exact look you want. Add your company logo, change fonts and colors, or add a useful widget or integration to make your application process even more efficient. Why not integrate with a secure payment gateway like Stripe or PayPal to securely accept application fees online? Be sure to keep patient data HIPAA-compliant with a Silver or Gold plan — this is especially important for sensitive health information submitted for medical card applications, medical reimbursement applications, and medical insurance applications. Streamline your application process with a free, online Medical Application Form today!

Coronavirus Screening Form

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Prevent the spread of COVID-19 with a free Coronavirus Screening Form. Ideal for doctors’ offices and telemedicine. HIPAA compliance option.

Healthcare Forms

Intake Form for Care Providers

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Use this detailed intake form for your healthcare/rehabilitation facility, capture patient information with an agreement between you and the patient.

Healthcare Forms

HIPAA Medical History Form

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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

Teletherapy Consent Form

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Collect informed patient consent and e-signatures online with a free Teletherapy Consent Form. Great for remote medical services. Get HIPAA compliance today.

Healthcare Forms

Pediatric Patient Intake Form

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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

Organ Donation Registration Form

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Signing up in a donor registry can be a daunting task. Help the donors to become a registrant by using this simple Organ Donation Registration Form which is very easy to use.

Healthcare Forms

Doctor Referral Form

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Efficiently write your Doctor Referral form by directly providing the information in the form. Don't waste time thinking what information is needed for referral and simply use this form and produce your referrals documents right away. Send your referrals instantly using this Doctor Referral Form.

Medical Application Forms

Spa Client Intake Form

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Avoid the hassle for your patient by using this Spa Client Intake Form wherein they can fill up before the scheduled therapy session. This form is easy-to-use and can be accessed to any device.

Healthcare Forms

Medical Insurance Application

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Medical Insurance Application

Healthcare Forms

Dietitian Patient Questionnaire

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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

Telehealth Psychotherapy Consent Form

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Get consenting e-signatures online from your psychotherapy patients. Easy to customize. Generate PDFs automatically. HIPAA compliance option. No coding.

Healthcare Forms

Medical Insurance Verification Form Template

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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

Medical Staff Application Form

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A handy form used as an application form for those who are looking for a medial staff. This gathers all the information needed to make sure they will hire the perfect fit for the job. It has personal details section, criminal background check, certifications and language fluency options, position and availability section, with fields where they can put their past experiences and personal references, and terms and condition section with signature field that will serve as a contract for both parties.

Human Resources Forms

Reiki Intake Form

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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.

Healthcare Forms

Chiropractic Intake Form

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Check the needs of the patient by using this Chiropractic Intake Form. This will serve as a health record of the patient where the chiropractors can base on how they will proceed with the treatment.

Healthcare Forms

Patient Intake Form

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Register new patients for your practice with a free online Patient Intake Form. Great for telemedicine or telehealth. Option for HIPAA compliance.

Healthcare Forms

Patient Encounter Form Template

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Monitor office visits with this free Patient Encounter Form. Easy to customize and fill out from any device. HIPAA compliance option. No coding required.

Healthcare Forms

Medical Card Application Form

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Medical Card Application Form

Application Forms

New Patient Medical History Form

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A detailed new patient intake form gathering their medical history information and further details with their consent to terms and conditions.

Healthcare Forms

Prescription Refill Form Template

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Prescribe medication refill online by using this Prescription Refill Form Template. This form template can be easily accessed in any device like smart phones, tablets, and laptops.

Medical Application Forms

Anesthesia Consent Form

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General anesthesia and consent form for surgery.

Healthcare Forms