Medical Questionnaire Form
Gather patient contact details and essential medical information effortlessly with this customizable and free medical questionnaire form. This basic medical questionnaire can be easily customized to align with your medical institution's unique healthcare practice requirements, so you can seamlessly integrate it into your existing flow. Embed the form into your medical office site or let patients fill in the form on mobile devices before an appointment or procedure. Form responses can appear in your system, filling corresponding fields of the patient card or in PDF format.
Structure and logic of the form
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The calendar start view is set up to show the years of the decade. Thus, patients can quickly find their birth year then select the month and date without endless scrolling of the calendar.
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To make sure patients are over 18 years old, the dates within the last 18 years are disabled. Specify the available date range in the calendar to efficiently schedule appointments, follow-up consultations, or treatment plans, track vaccination expiry dates, and more.
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To simplify the form-filling process and enhance the overall user experience, the age is calculated automatically when the date of birth is entered. The calculation is done using the Moment.js library. Use it to perform various date calculations: find the duration, add or subtract time, and determine the number of business days between two dates.
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The phone fields accept only 11-digit numbers to prevent input errors. It's done with Masked Text field type. Use it to specify a particular format and ensure accurate data collection for patient details, including social security numbers, health insurance policy numbers, and medical IDs.
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The email fields only accept data that matches the specified pattern to ensure users enter valid emails. Patterns are an alternative to the Masked Text field to restrict user input. Choose from predefined patterns or create your own to verify patient information.
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When patients answer 'yes' to any question, additional fields appear to collect more details. It's done with a JavaScript function and helps keep the form neat and user-friendly. In the same way, you can deactivate fields, make them mandatory, show or hide containers, change element styling, and more. Find code examples in the Manage fields article.
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Patients enter their medication list and medical history into the Data Table control. This way, you receive structured and complete data that is easy to analyze. Use tables to monitor vaccination, store and review laboratory test results, and track vital signs like blood pressure and heart rate.
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Patients confirm the accuracy of the data they have provided with a signature.