Details, contact preferences, the general reason for a first visit and a signature on your policies, over three short pages. It only asks who is filling it in when it's for someone else, and only asks what would help when someone needs an interpreter or access support. A welcome email is written and ready, held for a person to check; it switches on with Pro.
Clinics and medical practices taking on new patients, who want the front-desk details in before the first call.
It deliberately leaves out medical questions. Those belong in your clinical system, asked by your clinician.
Every question in this template
The pages as a respondent meets them. Pick any question to open it in the live preview above.
- Page 1Questions7 questions
- Page 2The visit4 questions
- Page 3Policies2 questions
- ThenThank you, you're registered
We'll be in touch within two working days to confirm and book your first appointment.
Conditional logic is already set up
Every answer, in one place
Each response lands in your inbox as a card like this one, with an email to you if you want it. People who stop part-way are kept too, with the answers they gave.
- Partial answers and drop-off by question, on every plan
- CSV, JSON and PDF on every plan, Excel on Pro
- Sheets, Slack, Notion, Airtable, HubSpot and webhooks on Pro
Maya OkaforClinic new patient registration · just nowNew- Patient's full name
- Maya Okafor
- Patient's date of birth
- 12 March 2027
- Your email
- maya@northstar.co
- Your phone number
- +44 20 7946 0321
- Home address
- 14 Hatton Garden, London
- Are you filling this in for someone else?
- Yes
and 7 more answers
Three steps, a couple of minutes
- Use this template1Make it your own copyIt becomes a draft in your account. Nothing you change touches the original.
- Reword, reorder, re-theme2Change anythingQuestions, pages, logic, theme and logo. It is an ordinary form from here on.
- formkit.app/you/clinic-new-patient-registration3Publish and shareYour own link, a QR code or an embed. Every answer lands in one inbox.
What this form can also do
Questions about this template
Can I use it for medical history or health records?
No. Formkit isn't built for medical or health records and doesn't offer HIPAA compliance, so this template stays at the front desk: details, the general reason for a visit and booking. Your practitioner goes through the rest in person.
Can a parent or carer fill it in?
Yes. One question asks whether it's for someone else, and only then asks for their name and how they're related.
Does the AI reply send itself?
No. On Pro the welcome email is drafted for each patient, and this template holds every one for a person on your team to read and approve first.