New patient form template

You’ll still have to put in the data yourself, but that’s about it. Our smart integrations take care of things like creating follow-up tasks, generating patient files and notifying relevant doctors of anything they need to know about the new patient.

When you hit the submit button, things get set in motion automatically. No more copy-pasting data into spreadsheets, much more time spent with patients.

We’ve given you some inspiration in the template, but don't stop there—you can completely customize it from head to toe. It’s even possible to upload files directly into the form.

Tracking progress and need a benchmark? Add a scale question to see how the treatment goes. Start playing around with the possibilities to see how you can transform your patient intakes.

Before you send out your form, there are two things you should do:

1. Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

1. Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.