Healthcare Form Templates

Registering new patients or learning about previous medical history are some of the processes made easier with our collection of online healthcare form templates. Our form builder provides Healthcare practitioners with an array of widgets, applications, and themes to enhance patient engagement. Enabling better communication between patient and provider, to better understand patients and their needs.

Get started by choosing one of our healthcare templates or start your customizing your own form. Additionally, JotForm offers the simple way to update medical history, acquire consent signatures, collect bill payments, find new business, and more. Plus, JotForm offers HIPAA compliant forms, so your paper healthcare forms are secure.

View our full collection of online healthcare form templates below.

Screening Checklist for Visitors and Employees

Preview

Prevent the spread of COVID-19 with a free Screening Checklist for Visitors and Employees. Ideal for hospitals or other organizations staying open during the crisis.

New Patient Enrollment Form

Preview

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.

Medical History Form

Preview

Medical History Form template allows tracking patient history with all their personal and contact information and also their illnesses and medication data.

Coronavirus Self Declaration Form

Preview

Employees can complete this form online and report any COVID-19 symptoms they may have. No coding required. HIPAA compliance option.

Personal Training Consultation Questionnaire

Preview

A training questionnaire collecting personal and contact, health, medication, habitual(smoking), occupational, physical information; with areas to fully understand the customer expectation and with package options to select from.

Patient Feedback Form

Preview

Get patient feedback with this online feedback form and improve your service.

Online Doctor Appointment Form

Preview

The template simplifies the process of scheduling doctors appointment with new and recurring patients through collecting relevant information of the patient and appointment. You can create a HIPAA compliant Appointment Form today

Massage Therapy Client Intake

Preview

Never thought you needed therapy? You can sign up for massage therapy with massage intake form template and you can create a HIPAA Compliant. Also, client intake form massage is used by Chiropractors. Massage therapy intake contains different questions about personal information, contact information, history of pathology and the client's symptoms.

Hospital Patient Registration Form

Preview

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.

Patient Medical History Form

Preview

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.

Psychiatric Evaluation Form

Preview

Use this neat and well-detailed psychiatric evaluation form to collect information about your psychiatric patients. This psychiatric evaluation form template can be customized to collect family history, list out symptoms and fields to input your examinations. Through JotForm your psychiatric evaluation template has access to an assortment of widgets and apps to make collecting the evaluation information easier. Get started with this our psychiatric evaluation form sample for a head start or create your own blank psychiatric evaluation form. Create a HIPAA compliant psychiatric evaluation form template today!

Intake Form for Care Providers

Preview

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

Client Progress Notes - Revised

Preview

Do you want to follow your clients progress notes? Create a HIPAA Compliant client progress notes sample and revised your psychotherapy client notes. Client progress notes template has personal information and five different classifications such as presentation assessment, safety and medical issues, subjective/objective part, interventions, and objectives and progress part.

Medical Employment Information Form

Preview

Here is an Employee Medical History Form that can be used to create an employee medical information database which provides employee contact information along with emergency contact information and medical insurance details.

Quick Emergency Contact Form

Preview

Collect emergency contact numbers from employees, patients, and more. Easy to customize. Works on any device. Integrate with 100+ apps for free. No coding.

Blood Donation Form

Preview

This blood donation form lets you provide a health clinic, hospital, or blood bank with the information they need to add you to their subscriber link for blood donors. Donors will submit their contact information and blood type to the clinic, securely. JotForm offers HIPAA compliance, so even the most sensitive patient data is safe. As is the case with all of JotForm’s form templates, this blood donation form is completely customizable. Add your logo, colors, images and more and start building out your list of blood donors today.

Gym health questionnaire Form

Preview

Do you need gym health questionnaire and searching for some gym questionnaire examples? Well, this is the simplest and easiest gym questionnaire template you can ever find. Let's check this out!

HIPAA agreement form -Health care operations.

Preview

With this HIPAA agreement form you can have your patients and users involved in health care operations to read and even sign the form.

Health Evaluation Form

Preview

If you have an online health service , this forms is suitable for you. Get your patient history, lifestyle and more. Customize it to your needs

COVID-19 Salon Company Consent form

Preview

This COVID-19 Salon Company Consent Formasks your customers to provide their personal information and service details with their acknowledgment of the COVID-19 measures and consent to obey the terms and conditions.

Alternative Medicine-Patient Intake form

Preview

Do you work for alternative medicine? This alternative medicine disclaimer form is very useful for those herbal medicine practitioners, wellness practitioners, alternative medicine practitioners, holistic medicine practitioners, etc. This holistic health intake form will help you to gather your patients' current diet information, health concerns, lifestyle information, education, physical activity, etc. You can create a HIPAA Compliant holistic nutrition intake form today.

Initial Visit Patient Forms (MDR)

Preview

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

Coronavirus Self-Assessment Form

Preview

Stay on top of COVID-19 prevention with a free online Coronavirus Self-Assessment Form. Send to patients who may have the virus. Collect data from any device.

MEDICATION LIST

Preview

Do you want to track your patient's progress? Cardiologist office requesting patients to complete a medication list prior to appointments. Medication list form contains personal information about the patient, patient medications which include all medications, over-the-counter, diabetic, dietary supplements and vitamins, smoking history, alcohol consumption and caffeine usage.

Healthcare PDF Templates

Trust, privacy, and security are the pillars that support every company in the Healthcare Industry. Each of these are carefully woven into their workflow and are intricate parts of the system they all live in. When you're in charge of someone else's healthcare needs, it's important to establish your company as a clean, trustworthy and professional business. A patient's well-being is not something anyone can afford to take a chance on. So, hospitals and medical practitioners go to great lengths to make sure that their patients will trust them.

That’s why the HIPAA compliance act was put in place – To ensure the privacy of the patients’ medical records. And you’re in luck with JotForm being one of the few companies in the online form building industry that is HIPAA-compliant. With our PDF Editor, anyone in the Healthcare Industry can create fillable PDF forms or generate PDF documents as an attachment to their Autoresponders. Instead of designing one from scratch, we offer a wide variety of PDF templates that you can use as an inspiration for your next design project.

These PDF templates can be used in many use case scenarios. For example, you need to hand out brochures about the health services you offer. Instead of handing out paper-based flyers and pamphlets, why not use something like an electronic brochure in PDF format? You can distribute these to your potential patients right after they fill out their information through an online registration form for new patients. Or, you can design a simple yet beautiful fillable PDF form that you can download and print as a paper-based form in case you need one for your hospital’s outpatient department.

Professional Medical Release

Preview

This Medical Consent PDF template includes knowledge belong to your clients such as their contact, work, spouse, policyholder, in case of an emergency contact information, the consent, and signature. In addition, you can create a Medical Consent PDF template with HIPAA Compliant.

Simple Medical History

Preview

Once you have collected these medical data, you can record them as a pdf by using this medical history PDF template. In addition, you don't need to be worried about the safety of data, because our forms are HIPAA compliant.

Online Therapy Consent

Preview

This Online Therapy Consent contract sample is a perfect fit for you, if you want to check your patients' crucial data and record their data without any problem. By using this Online Therapy Consent PDF template, you can get online permission from your patients. Moreover, you can print out your consent PDF template for the patient's patient folder. You may collect personal information such as their name, birth date, and contact information. Also, you may inform your patients about their rights with respect to telemedicine with their signature. In addition, you do not have to worry about your data's safety, our forms have HIIPA Compliance.

Patient Medical Record

Preview

Medical History Record PDF template lets you collect the patient's data such as personal information, contact information in an emergency case, general medical history. By using this sample, the doctor ensures the patient's better care and treatment.

Hospital Discharge

Preview

It is a good practice to always crosscheck and make sure that everything is in order before discharging a patient. In order to ensure this, hospital management usually has a form which they fill and check in before discharging a patient. In our world today where people are using less of paper, this hospital discharge template is one PDF document you can use to save patient discharge information. The essence is that you can easily check the information saved in the PDF document to ensure a patient can be discharged. The hospital discharge letter template here can be modified to suit your taste.

Short Medical History

Preview

Medical History Record PDF template is mostly used in order to provide significant information about the health history, care requirements, and risk factors of the patient to doctors. It is for collecting data from the patients.

Pregnancy Verification

Preview

A Pregnancy Verification document is used in hospital, maternity, and lying-in clinic settings. This is given to a woman who gets positive feedback on pregnancy tests. This document also serves as proof that a woman is pregnant which can be used for medical examination, filing a maternity leave, and claiming health insurance.This well-designed Pregnancy Verification Template contains information about the patient, pregnancy, and ob-gynecologist. The pregnancy details show the estimated date of conception, last menstrual period, estimated delivery date, age of gestation, and the number of fetuses. This template also specifies if the mother has a medical condition, illnesses, and allergies.

Medical Invoice

Preview

This medical invoice sample contains the medical institution, the name of the physician, the name of the patient, the medical services rendered, as well as the materials used. The costs incurred for each service and the materials are also included in this medical invoice sample. You can easily modify this template based on your own style or liking.

Dental Health Record

Preview

The Dental Health Record Template is easy for patients to fill out and designed to get the doctor the most important information. Patients can fill out their information on a computer or tablet using our Dental Health Record Template.

Client Progress Report

Preview

Client Progress Report for Psychotherapy PDF template provides the essential information that should contain in a clinical psychotherapy report such as the name of the patient, the type of session made with the patient, the date of the session, a comprehensive assessment, and treatment goals and objective for the patient/client.

Insurance Waiver

Preview

Insurance is usually offered by organizations to their clients, customers such as passengers, or employees. It helps protect the company or an institution in cases of fortuitous events incurring liabilities. However, insurance companies usually do not allow double insurances or it causes more problems rathe