Health Evaluation Form Template

Health Evaluation FormFirst things first, what's your name?What's your date of birth?How would you rate your health at the moment?Are you suffering from any of the following?

Heart disease, Weight loss, Chronic pain, Asthma, Mental health problems, Nope, I'm all clear

If you're taking medication, please tell us the name and dosageBefore you go, can we get your phone number? We'll use this to follow up if we need toThanks for your time, {{field:213e1ad1-688e-46be-91cc-3b7b48acad03}}!

Collect up to 3.5x more data with Typeform

The all-in-one tool for running pulse checks on your people

Whether you're assessing the wellbeing of patients, students, or employees, this online health evaluation form can flex to fit your needs. Say goodbye to paper forms, emails, and manual errors. Instead, say hello to automated admin tasks, seamless workflows, and lots more free time.

With Typeform, you can customize everything

Change text, colors, and even logos to match look and feel of your brand. Then embed forms smoothly onto web and email.

Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.

Stay efficient by connecting forms to your workflow. Typeform integrates with 120+ tools including Slack, Zapier, and HubSpot.

Health evaluation form FAQs:

You'll be pleased to know, this powerful online form does most of the hard work for you.

Our pre-made template is a great place to start. We've included some key questions in here (all tied together with a slick design), so you can use what's there or customize it to suit you.

Our forms are mobile-friendly and come pre-designed, so you don't need to worry about coding or making it look good. When your form's finished, simply click 'publish' and start sharing—you can easily embed it into your website or intranet, share the link directly, or embed it into an email.

When responses come in, our integrations can organize them for you. Bring data to life with a Google Sheets integration, send follow-up emails with a Mailchimp integration, and let Google Drive sort responses into folders. And that's just the start.

Health evaluation forms are typically used by medical centers or doctors taking on new patients. They might also be used by companies or sports clubs, for emergency or insurance reasons.

These evaluation forms are great for gathering sensitive data in a secure, efficient way. And with this template, you can collect as little or as much info as you like, thanks to our flexible form builder.

We'd recommend starting with the basics, like name, date of birth, and address—the key stats you'll want on file. Then, it's up to you. You can find out what medication people are taking, and if they have any underlying health conditions. You can even get people to rate their current physical and mental health using an Opinion Scale question type.