Medical Card Application Form Template

Use this medical card application form to receive all your requested information from your applicants much faster. You can customize this template in any way you want using our form builder.

Customize template

Make it easy for patients to apply for a medical card with this pre-made template that you can quickly modify as needed. Add more fields to request further information or eliminate them if you require fewer details. Modifications to the form do not involve any programming, you can do it by yourself with the drag and drop form builder tool. Upload the healthcare facility logo and change the color scheme, add a reCaptcha and password protect your form.

Publish template

Applying for a medical card is possible even from smart devices, as our web forms are mobile-responsive. Embed the medical card application form in your facility’s website with a simple copy and paste, or share the form link on a social media page to make it easy for responders to react.

Collect & manage data

Patient responses are safely secured in a data repository attached to the form. You can fully access this database and download the entries in CSV, Excel or PDF format. If needed, syncing with Google Drive or other applications is possible due to our many available integrations. From the Reports section, you can create custom reports with visual representations. If you need HIPAA compliance, 123FormBuider is capable of securing your ePHI with its built-in HIPAA features that are available on the Enterprise plan. So, you’ll be able to make HIPAA-compliant online forms for medical card applications and other forms.

Optimize processes

Going paperless has never been easier. Each time someone submits a medical card application, you will be notified by email or SMS. Our form builder is an intuitive tool that speeds up the medical data gathering process. It delivers all the necessary patient info in a simplified form and leads to better healthcare services.