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

Replace paper intake forms with digital forms to speed up workflow and reduce administrative errors. Patient submissions are stored in a secure online database so all information is organized and accessible.

Protect with HIPAA Compliance

Use HIPAA-friendly features of Jotform on eligible plans to safeguard sensitive patient data with a signed Business Associate Agreement (BAA). Secure intake forms help healthcare teams meet regulatory requirements and protect privacy.

Collect E-signatures

Let patients sign forms electronically on any device to eliminate the need for printing or scanning. Electronic signatures help complete consent forms and other documents faster and more conveniently.

Works on Any Device

Ensure patients can complete intake forms on smartphones, tablets, or computers. Mobile-friendly forms improve accessibility and help healthcare providers collect information anytime, from anywhere.

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