New Patient Registration Form
Make your intake process easier for both your team and your new patients with this HIPAA-compliant registration form. It covers all the essentials—personal details, insurance info, and health history—in one secure digital step. By moving your registration online, you can cut out the messy paperwork and reduce manual data entry errors. It's fully customizable to fit your practice's specific workflow and can be embedded right on your site for easy access from any device.
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 through 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 Email field accepts only data matching a specified pattern to ensure valid email entries. Choose from predefined patterns or create custom ones to verify customer information.
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The Phone field accepts only valid phone numbers. You can select which country's formats are accepted in the field properties.
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When patients answer 'yes' to medical history and lifestyle questions, extra fields appear to collect more details. This is done with conditional rules in the Hide property of the fields.
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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.