Employee medical form template

Employee Medical FormFirstly, what's your name?and your company email address, {{field:2305caa7-5d48-4f7a-87c5-73789b5f51e3}}?What's your home address?Who's your emergency contact?Please include their relationship to you in brackets, e.g. (SPOUSE)and what's their phone number?If you've got any allergies, list them hereAre you on any medication? If so, please list them hereDo you suffer from any of these?

Arthritis, Chronic respiratory problems, Heart disease, Diabetes, High blood pressure

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Make gathering details quick and easy with this employee medical form. Customize it, set up integrations, hit “share” and watch your data organize automatically.

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

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Employee medical form FAQs:

An online form streamlines the information collection process in two ways. First, it plots the data into fields, meaning there’s no manual cutting and pasting to be done. Simply export your responses and you’ve got an organized spreadsheet. Second, it does the hard work for you when it comes to collection. No back-and-forth emails or digging around for stray pieces of info—gather everything at once in one single step.

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

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.

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.