Patient Confidentiality Agreement

About this template

Give your patients peace of mind that their sensitive medical data is safe with this Patient Confidentiality Agreement. Simply customize this template however you see fit, then share your form via email. Patients can then fill out this agreement form from any smartphone, tablet, or desktop computer. You’ll receive an email notification and a signed and finalized version of the document in your online dashboard.

Make changes to this Patient Confidentiality Agreement with our drag-and-drop builder. Change the agreement terms, add new text boxes or signature fields, upload your clinic’s logo, choose fonts and colors, and much more without any coding knowledge. Once a patient fills out and signs your document, you can instantly print and download it as a PDF document for your records. Say goodbye to messy paperwork and keep everything safe and secure with Jotform Sign.

Related templates

Power of Attorney Form

Create a professional power of attorney form. Signable on any smartphone, tablet, or desktop. Easy to customize and share with others. Converts to PDF.

Professional Physical Therapy Consent Template

Create a professional physical therapy consent form. Collect e-signatures on any smartphone, tablet, or desktop. Easy to customize and share.

Professional Medical Release Template

Create a professional medical release template. Great for medical practices and therapists. Collect signatures online. Converts to PDF. Easy to customize and share.

Medical Records Release Authorization

Build a medical records release authorization form in seconds. Works on any device. Android and iOS compatible. Converts to a PDF. No coding knowledge required.

Summer Camp Parental Consent

Create a summer camp consent form for parents of your campers. Intuitive form building. No coding required. Drag and drop to design. iOS and Android compatible.

Hospital Discharge Template

The Hospital Discharge Template is a detailed document that provides patients with instructions and information upon discharge from a healthcare facility

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.