Online Patient Intake Forms
Eliminate messy paperwork while protecting health information with Jotform’s HIPAA-friendly online patient intake forms. Collect payments, file uploads, e-signatures, and more. Get responses on any device.
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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
Plastic Surgery Patient Intake Form
Coronavirus Suspected Patient Intake
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Create Patient Intake Forms
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Ditch paper and enjoy a more efficient way to collect patient intake forms. Jotform helps you digitize your intake process and creates a secure online database of all your patients’ information.
Protect with HIPAA Compliance
Rest easy knowing that patient data is safe and secure. Opt into HIPAA compliance on our Gold, or Enterprise plans to get a signed Business Associate Agreement (BAA) and meet HIPAA requirements.
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Get electronic signatures from any device. It’s a great way to cut down on paperwork and stop patients from having to print, sign, scan, and send their documents by hand.
Werkt op Elk Apparaat
Jotform’s online patient intake forms work seamlessly on any device — so your patients can enter their medical history, pay their bills, and sign documents from their own smartphone, tablet, or computer.
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