Use this nursing home application form template in your organization, tune it up as needed and publish it anywhere on the Web.

Customize template

Need a more efficient way to place candidates for assisted living? Create an online request process using this nursing home application form template. Think you need coding know-how? Think again! Simply drag and drop the text fields, checkboxes, radio buttons, and any other question types you need from the applicants. Then personalize the design and assign the email addresses which will receive the submissions.

Publish template

Once you have the nursing home application form ready, you’ll be able to integrate it with your website. Just copy and paste the embed link to any page. If you make future changes to the form, it will be updated automatically. Additionally, the application is readily shareable by email or over social media using the shortcut buttons in the form editor. The form is easy to use on computers, smartphones and tablets thanks to a responsive layout that adapts to screen size and input method (keyboard or touchscreen).

Collect & manage data

A lesser known benefit of having an online nursing home application form is the submission database behind the scenes. All applications are securely stored in your 123FormBuilder account where you can review them or export to your device as Excel, CSV or PDF. If you desire, you can also view analytics about the applicant pool. In addition, you can sync your form with a wide variety of productivity, CRM and payment gateway apps, including Dropbox, Salesforce, Constant Contact and Authorize.Net.

Optimize your flow

An online nursing home application form is a giant step toward streamlining your assisted living intake process. Specifically, your staff will save vast amounts of time once the data entry workload from legacy paper forms becomes a thing of the past. The forms themselves will be more clear and complete through field validation (i.e., automatic checks for completeness and formatting) as well as the simple fact that the applications will not be handwritten! Finally, configurable notifications ensure that assisted care placement staff receive the requests promptly.