The Medicine Order Form Template by WPForms is designed to simplify the process of accepting online orders for medicines. This form template can help healthcare providers and pharmacies to collect essential patient information and manage medication orders efficiently.
How Does the Medicine Order Form Template Work?
Here’s a detailed list of the form fields to help you understand the form better and tweak it further if needed.
- Name: This field records the patient’s full name for identification and record-keeping.
- Phone Number: Collects patient’s contact information, enabling direct communication between the patient and the seller.
- Date of Birth and Age: Here, the patient can provide their date of birth and age details. This information is required to ensure adherence to age-related medication guidelines.
- Gender: By knowing the patient’s gender, you can understand different body requirements.
- Delivery Address: Collects the patient’s delivery address to send delivery shipment.
- Doctor Name: This field records the doctor’s name of the patient for prescription verification purposes.
- Doctor Phone: By collecting the doctor’s number, you can contact the doctor in case of any emergency or for other relevant communication purposes.
- Upload Image of Doctor’s Prescription: Here, the patient has to upload files of the doctor’s prescription. This field helps in the verification of medical needs and regulatory compliance.
- Medicine List: This field provides checkboxes for different medicines along with their prices. The total amount will be automatically calculated based on the patient’s selection.
Use this form template to accept online medication orders and payments seamlessly. This form captures all the necessary information to deliver the ordered medicines easily.
So what are you waiting for? Sign up with WPForms today to get access to the Medicine Order Form Template to elevate your medication services.
