Customize template

Ready to move your hospital’s patient intake process online? Here is a hospital registration form template that you can tailor to your facility’s needs. The drag and drop editor makes it easy to add, remove and rearrange questions as well as personalize the design. Collect data in any format—dropdowns, checkboxes, text fields, and many more. Best of all, alert designated medical staff immediately upon each intake in order to help them prepare beds and other resources.

Publish template

There are many easy options for sharing your hospital registration form with staff. First, the form has its own web address, which you can copy and paste to any document or other location. There are also handy share buttons that send the link to an email or into a social media post, such as in a closed group. Finally, if your medical facility has an intranet site, you can embed the form into a web page there. No matter where it lands, the responsive design helps the form work seamlessly on a variety of displays, including tablets and smartphones.

Collect & manage data

All patient enrollment data submitted to the hospital registration form goes to a secure database in 123FormBuilder. There the information can be exported to Excel and CSV for use in your patient tracking system or turned into printer-friendly PDFs. In addition, built-in analytics tools give you the opportunity to analyze patient demographics. Finally, the form can integrate with a variety of services, due to our 30+ third-party integrations.

Optimize your flow

Streamline your hospital administration processes with an online intake form. By moving away from paper, patient registration will go much faster, and you’ll eliminate the need for keying patient data into proprietary systems. Furthermore, if your hospital ever starts over with new patient management software, the handy export from your hospital registration form can be reimported into the new system.

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