Medical Application Forms
347 Templates
Medical Patient Intake Form
A medical patient intake form is used by medical professionals to collect new patients’ medical history, contact details, insurance information, and more. With Jotform’s online Medical Patient Intake Form, your healthcare organization can seamlessly collect patient intake forms and e-signatures from any device. Simply customize the form template design and then share it with a link or embed it in your website to start securely collecting patient information online.
Feel free to add your logo, include extra form fields, and more with our drag-and-drop Form Builder. Once you’ve collected submissions, you can manage your patients’ details in Jotform Tables as a spreadsheet, calendar, or cards. The days of paper forms are over — reduce in-person contact, improve your workflow, and save time with an online Medical Patient Intake Form!