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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}}!

Rated 4.5 out of 600+ reviews on G2.com

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.

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.

Make life easy with integrations

Google Sheets

Salesforce

Slack

Google Analytics

Zapier

HubSpot

Here's what people say about us

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

Form builders are as old as the web, but Typeform elevates the medium substantially.
Johnny Rodgers
Product Architect

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study
Kate Donhoe
Head of Product Marketing

Leads from the Typeform integration were twice as likely to convert.
Tobias Wasmer
Marketing Manager @ Volvo Cars

You used to need developers to do all this. Not anymore.
Kyle Maltz
Chief Operating Officer

Typeform is a production-grade system for our entire growth funnel.
Gaurav Vohra
Head of Growth

Typeform helps me attract more responses and a higher response rate than other tools.
Rand Fishkin
CEO + Founder

87% of users reported higher completion rates after switching to Typeform

Health evaluation form not right?

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Other categories used by people like you

Order forms Application forms Feedback forms Lead Generation Quizzes Feedback surveys Customer satisfaction surveys File upload forms Evaluation forms Job application forms Marketing surveys Event forms Event surveys

Health Evaluation Form Template

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

Health evaluation form FAQs:

How do I collect health evaluation data?

What is a health evaluation form?

Make life easy with integrations

Here's what people say about us

Health evaluation form not right?

Other categories used by people like you