An emergency visit registration form is used by medical facilities to collect information from patients when they check into the hospital under emergency conditions. Set up an online Emergency Visit Registration form to collect contact information, health history, and insurance details from patients. Simply customize the form to fit your practice’s needs, then embed it in your website, share it with a link, or use it with Jotform Mobile Forms on your tablet or phone.
With Jotform's 100+ free third party application integrations, you can send collected responses to your CRM or storage service of choice such as Google Drive, Google Sheets or Dropbox. You can also configure each form field and change the design of your forms according to your facility's needs with Jotform's free Form Builder app. View responses and get the information you need from patients with a free online Emergency Visit Registration Form.