Patient Demographic Form Template

Use this all-in-one template to easily collect patient demographics, along with important intake details like emergency contacts and insurance.

Simplify your workflows

Help providers tailor the patient experience with important data. Collect demographic information like marital status, race, and employment status to better know and understand those you care for, all in an easy-to-use patient demographic form you can act on later or send to patients to fill out before their first appointment. Exceed compliance standards with Formstack's HIPAA compliant forms. Get started with this patient demographic template.

Reduce risk with HIPAA compliance.

Concerned about HIPAA? Don’t be. With a custom-made HIPAA account, you’ll always meet regulation standards with special features that will help you properly collect, store, and distribute medical information. Safely embed forms on your website for easier distribution.

Keep waiting rooms clear

Speed up the form-filling process with a patient demographic form that patients can fill out on their phones before they arrive. Share the form on your website or email it out to patients ahead of time so they can skip the paperwork and complete forms on any device at their convenience.

Build loyalty to your practice

Create a complete patient experience by including your practice’s branding. Use the Theme Editor to add logos and tweak design elements without fussing with code. Add Conditional Logic to automatically hide or reveal certain questions depending on the patient’s answers.

Streamline your data collection

There’s a lot of information to collect when it comes to new patients. Make it easier with our Portals feature by organizing all your forms in one place, gently nudging patients with automated reminder emails, tracking completion rates, and boosting efficiency across departments.

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