Patient Registration Form Template

Take care of patients' convenience and save their time thanks to online registration forms
Patient Evaluation Form

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?

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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?

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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

City

Address of residence (street, house / flat number, zip code)

E-mail

Phone number

Appointment details

Specialist / doctor

Preferred date of the visit

Additional remarks

Do you have health insurance?

Try this template

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Customer Experience example

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.

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Connect tools that you are using, Responsly easily integrates with multiple apps.

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