New Patient Registration Form
This online form template for new patient registration will streamline the intake process for healthcare practices. The registration form includes personal details, insurance information, and a health history questionnaire. It will help eliminate paperwork, reduce errors, and enhance both the doctor and the patient experience. Integrate the form into your website for convenient new patient registration from any device. Customize it to fit your medical practice's needs.
Structure and logic of the form
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The form is divided into logical sections using the Tab container. This way, new patients won't get overwhelmed by filling out a never-ending form but will move step by step.
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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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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 medical history and lifestyle questions, extra 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 provide their responses about lifestyle using the Likert scale. It allows you to collect structured and comprehensive data, making analysis straightforward. Use the Likert scale in medical practice to measure pain, treatment effectiveness, patient satisfaction, and overall well-being.
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Patients confirm the accuracy of the data they have provided with a signature.