Healthcare Form Templates
Medical forms need extra care: sensitive data, detailed questions, conditional logic for follow-ups, secure file uploads for insurance cards and previous records, and consent fields with legal weight. Form Forge ships 8 healthcare form templates built for clinical workflows.
Healthcare templates
New Patient Intake Form
Multi-step form covering personal info, contact, insurance, medical history, current medications, allergies, family history, emergency contact, and consent. Designed for first-time patients at any clinic.
Appointment Request Form
Patient name, DOB, contact, insurance provider, reason for visit, preferred provider, preferred date/time (Google Calendar date picker), existing patient flag that skips intake.
Medical History Form
Current conditions, past surgeries, medications (via repeater), allergies (via repeater), family history, lifestyle questions (smoking, alcohol, exercise). Each section expands based on answers (conditional logic).
Insurance Verification Form
Patient info, insurance provider, policy number, group number, insured’s name and DOB, relationship to patient, front-of-card photo upload, back-of-card photo upload.
Telehealth Consent Form
Patient identification, informed consent text (HTML block), understanding of risks and limitations, signature field, date, emergency contact in case technology fails.
Pre-Surgery Questionnaire
Medical history, current medications, allergies, previous surgeries, anesthesia history, recent illnesses, last oral intake, consent to anesthesia. Typically multi-step with 4–5 sections.
Physical Therapy Intake
Patient info, referring physician, reason for therapy, pain scale, functional limitations, goals, previous treatments, insurance, consent.
Medication Refill Request
Patient info, medication name, dosage, last refill date, pharmacy, preferred delivery method, urgent vs standard. Pre-validates basic info before sending to the provider.
Important notes for healthcare providers
HIPAA and compliance
Form Forge is a WordPress plugin running on your server with your data. It does not inherently make a site HIPAA-compliant — HIPAA compliance depends on your entire infrastructure (server, database, email provider, backups, access controls), not just the form tool.
That said, Form Forge’s architecture helps:
- Data stays in your databaseno third-party SaaS storing submissions
- Encrypted HTTPSenforce SSL site-wide
- Capability-based accessonly users with the right WordPress roles can view submissions
- Audit trailsubmission edits are logged
- Secure file uploadsfiles stored outside the public directory
- No third-party analyticsForm Forge doesn’t ping external services for tracking
For full HIPAA compliance, work with a HIPAA-compliant WordPress hosting provider and consult your compliance officer.
Consent fields
Every healthcare template includes explicit consent fields with clear language about data use. Consent is captured as a form field and stored with the submission for the audit trail.
Signature fields
Drawn signature fields (the user signs with mouse or finger) are available for forms that need a legal signature. Signatures are stored as image data with the submission.
Conditional logic for medical follow-ups
Healthcare forms lean heavily on conditional logic. Examples from the templates:
- “Are you currently taking any medications?” → if Yes, show a repeater field to list them
- “Any known allergies?” → if Yes, show severity and reaction fields
- “Previous surgeries?” → if Yes, show a repeater with surgery type and date
- “Pregnant or breastfeeding?” → if Yes, show pregnancy-specific questions
- “Blood pressure medication?” → if Yes, show current BP reading field
Keeps the form short for healthy patients and thorough for patients with complex histories.
File uploads for insurance and records
Healthcare templates use file upload fields for:
- Insurance card photos (front and back)
- Previous medical records (PDF)
- Imaging results (JPG, PNG, PDF)
- Referral letters (PDF)
Uploads are stored in a quarantined directory outside the public uploads folder. Only users with the right permissions can access them from the WordPress admin.
Ready to digitize your intake process?
Healthcare templates are included in every version of Form Forge. Consult your compliance officer about full HIPAA requirements for your infrastructure.