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Telehealth Forms

112 Templates

Telehealth forms help healthcare practices schedule virtual appointments with patients and collect medical records, informed consent, fee payments, and other important health data online. Whether you’re part of a doctor’s office, teletherapy practice, or dermatology center, you can use Jotform’s free telemedicine forms to securely gather important patient information and diagnose conditions through your website. Simply choose a readymade form template from the list below, customize it to match your practice by adding your logo and updating form fields, then embed it in your website or share it via email to start collecting info online.

To help keep sensitive health data protected, be sure to sign up for HIPAA compliance features by signing a Business Associate Agreement (BAA). You can even automatically send form submissions to other platforms you’re already using, like Google Calendar, Dropbox, Google Drive, and more. Jotform offers an all-in-one solution to collect important info from your patients online — so take your telemedicine practice to the next level with our free Telehealth Forms.

Form Templates: 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.

Patient Registration Form Templates
Form Templates: Coronavirus Screening Form

Coronavirus Screening Form

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

Coronavirus Response Forms
Form Templates: Sample Request Form

Sample Request Form

A sample request form is a quick and easy way to ask for examples of a product or service from a business.

Request Forms
Form Templates: Telehealth Consent Form

Telehealth Consent Form

Get informed consent from patients online. Collect electronic signatures. Easy to customize for your practice.

Telehealth Forms
Form Templates: 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.

Telehealth Forms
Form Templates: Teletherapy Consent Form

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.

Telehealth Forms
Telemedicine Consent Form

Telemedicine Consent Form

Get consenting e-signatures online from your patients. Add terms and conditions without coding.

Consent 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.

Medical Surveys & Questionnaires
COVID 19 Patient Screening Questionnaire

COVID 19 Patient Screening Questionnaire

A COVID-19 patient screening questionnaire is used by medical practitioners to ask patients about their family and medical history.

Coronavirus Response 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.

Healthcare Forms
Reiki Intake Form

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.

Telehealth Forms
Virtual Care Appointment Form

Virtual Care Appointment Form

Easy appointment scheduling for e-visits. Great for telemedicine! HIPAA compliance option. Embed anywhere. Integrate with 100+ apps. No coding required.

Appointment Forms
Physician Referral Form

Physician Referral Form

Refer patients to other physicians and collect referrals online. Easy to customize and embed. Integrate with 100+ apps. HIPAA friendly features option. No coding.

Telehealth Forms
Telehealth Counseling Consent Form

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 friendly plans.

Telehealth Forms
Telemedicine E Visit Request Form

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 features.

Telehealth Forms
Sample Telemedicine Consent Form

Sample Telemedicine Consent Form

Collect informed consent and e-signatures from patients with a free Sample Telemedicine Consent form. Easy to customize, embed, and share. HIPAA friendly features option.

Medical Consent Forms
Telehealth Clinical Assessment Form

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.

Telehealth Forms
Medical Volunteer Application

Medical Volunteer Application

Collect medical volunteer registrations online with our free Medical Volunteer Application Form. Easy to customize and embed. Ideal for emergency response.

Volunteer Application Forms
Dermatology Telehealth Medical Examination Form

Dermatology Telehealth Medical Examination Form

Treat patients remotely. Safely collect medical info online. HIPAA friendly features option. Accept photos of skin conditions. 30+ free payment app integrations.

Telehealth Forms
Telehealth Physical Therapy Consent Form

Telehealth Physical Therapy Consent Form

Offering virtual physical therapy appointments? Collect signatures and payments from patients online. Easy to customize and integrate. HIPAA compliance features.

Telehealth Forms
Lifemark Informed Consent Telehealth Treatment

Lifemark Informed Consent Telehealth Treatment

Collect signed patient consent forms online with our free Mental Telehealth Informed Consent Form. Easy to customize and embed. Opt for HIPAA compliance features.

Informed Consent Forms
Telemedicine Patient Evaluation Form

Telemedicine Patient Evaluation Form

Evaluate your patients remotely with an online Telemedicine Patient Evaluation Form. Easy to share and collect data on any device. Opt for HIPAA compliance features.

Telehealth Forms
Teledentistry Consent Form

Teledentistry Consent Form

Collect consent from patients online. Perfect for dental practices offering virtual care. Easy to customize and embed. Integrate with 100+ apps. No coding.

Telehealth Forms
COVID Plasma Donation Form

COVID Plasma Donation Form

Survivors can apply to be blood donors through this online plasma donation form. Easy to customize, embed, and integrate. No coding. HIPAA compliance option.

Donation Forms

These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.