Are you looking for a medical information form to record personal medical information for patients, staff, students, or clients?
Our customizable medical information form template will help you to collect critical information so you can be prepared in case of a medical emergency.
How Do You Create a Patient Information Sheet?
A patient information sheet should include a patient’s personal details such as name, age, and contact details, as well as their medical history, details of medications and allergies, and any other medical information that may be relevant.
The patient information sheet can be used to take information about a patient’s medical history and record consent before a procedure.
Medical information forms can also be filled out when an individual is registering at a medical clinic, workplace, school, college, care home, or other facility.
Collecting this information means that staff and carers will be aware of any potential medical issues and can provide effective first aid in the event of a medical emergency.
Using the Medical Information Form Template
This editable medical form template is pre-built with fields for the patient’s name, date of birth, and contact information. The medical history section has fields to collect details of current medical treatments, medications, previous illnesses and injuries, allergies, and other medical conditions. There’s also a section to collect the name and contact details of an emergency contact.
To help with compliance and legal protection, this form template includes a terms and conditions field that you should edit with your own terms. The user must tick to agree to the terms and conditions before the form can be submitted. There are also fields to collect the signature of the patient and the date the form was submitted.
You can customize this form by adding, removing, or editing fields to suit your needs. For example, you may want to add an additional GDPR agreement if you’ll be collecting medical information from users in the EU. You can also use WPForms addons, such as the Form Locker feature, which you can use to restrict access to the form to authorized persons.
Get started with WPForms today to get access to this medical information form template and hundreds of other customizable form templates.
