Online Patient Intake Forms

Jotform’s online patient intake form helps healthcare teams create and collect patient intake data securely without writing code. Build HIPAA-friendly intake forms that capture medical history, payments, file uploads, and e-signatures on any device. Jotform simplifies patient onboarding while protecting sensitive health information.

Templates

Free Patient Intake Form Templates

Create a custom form fast with ready-made patient intake form templates. Just customize a template to match your branding and share it to start collecting submissions!

Medical Patient Intake Form

Template 202373620102944

Plastic Surgery Patient Intake Form

Template 211263681444958

Coronavirus Suspected Patient Intake

Template 200772578426057

Benefits

Create Patient Intake Forms

Go Paperless

Ditch paper and enjoy a more efficient way to collect patient intake forms. Jotform helps you digitize your intake process and creates a secure online database of all your patients’ information.

Protect with HIPAA Compliance

Rest easy knowing that patient data is safe and secure. Opt into HIPAA compliance on our Gold, or Enterprise plans to get a signed Business Associate Agreement (BAA) and meet HIPAA requirements.

Collect E-signatures

Get electronic signatures from any device. It’s a great way to cut down on paperwork and stop patients from having to print, sign, scan, and send their documents by hand.

Works on Any Device

Jotform’s online patient intake forms work seamlessly on any device — so your patients can enter their medical history, pay their bills, and sign documents from their own smartphone, tablet, or computer.

Testimonials

What our users say about Jotform

Jotform is an amazingly convenient tool for web design teams. We use it for both our client’s sites and our own. Jotform supports our client’s form goals without affecting the feel or purpose of the design. The integrations and automations save us a ton of time. We can customize the form and its function as we see fit. We are even able to customize email notifications with our own HTML. We’ve come upon other form providers over the years but they don’t compare as Jotform is continually advancing. Keep up the good work!

Andrew Jones, Web Designer, UpEngine