Patient Registration Form Template
The patient registration form will help you effectively manage your and your patients' time.
Patient registration forms are used to register patients for procedures offered at medical facilities. Whether you need to register new patients for your hospital, clinic, health center, or private practice, Patient Registration Forms will streamline the registration and onboarding process by seamlessly gathering patient information online. Simply customize templates to match your medical facility, and you’ll be registering new patients in no time! Patients will be able to provide their personal information, provide emergency contact numbers, write down their medical histories, attach files, and submit payments all at once.
What are the benefits of using a patient registration form?
An online registration form helps you save time, boost productivity and keep patients happy. Send patients a link to the form when they arrive, and they can fill it out in the waiting room before their appointment. With patient registration forms, you can significantly reduce paperwork and patient wait time.
Can I also prepare an appointment registration form?
Definietly! Your patient can book an appointment in a matter of seconds. Doctor appointment form works on any device, so patients can even fill it out on the go. It’s easy to use, showing only one question at a time on the screen. Patients can briefly indicate the reason for their visit, pick a date that fits them, then wait for you to send their appointment time via email—all without having to call up or wait on hold.
Examples of Patient Registration Form Template questions
Here are examples of questions most commonly used in Patient Registration Form Template. When using our template, you can edit and adjust all the questions.
Name and surname
Personal ID Number
Address of residence (street, house / flat number, zip code)
Specialist / doctor
Preferred date of the visit
Do you have health insurance?
Try this template
62% of our surveys are opened on mobile devices. Responsly forms are well optimized for phones and tablets.
Responsly get 2x more answers than other popular tools on the market.
Responsly service get an average satisfaction score of 98%
Related Registration templates
Customize template for your needs
Modify or add questions
You can modify every question, delete or add more; there are 24 types of questions with options to select.
Add your branding
Make it looks like it's your own. Add branding of your organization and modify the theme to match the graphic standards of your brand.
Connect with your apps
Easily connect Responsly to apps that you’re using. Use ready integrations to move data from Responsly to your apps automatically.
100+ apps integrations
Connect tools that you are using, Responsly easily integrates with multiple apps.
Responsly employee experience platform helps us control employees' satisfaction and communication inside our organization.
Alicja Zborowska, Administration Specialist
We automated the product experience control process.
Controlling customer experience is easy with Responsly.
Our suppliers are surveyed quickly and efficiently.