Patient Demographic Form Template

If you’re running a healthcare facility, the Patient Demographic Form Template will help you easily collect the demographic and personal data from your patients before or upon admission. Collecting demographic information online is faster and more secure: unlike paper forms, online records can’t be as easily lost or stolen. You can easily edit this patient demographic form template using our form builder and publish it anywhere online.

123FormBuilder / Form Templates / Medical Forms / Patient Demographic Form

Start with this template

Available on a paid plan

Frequently Asked Questions

What is patient demographic form?

Patient demographics forms allow for the identification of a patient and his categorization into different segments for the purpose of research and clinical trials.

What should a patient demographic form include?

The patient demographic form includes personal information about the patient like contact info, emergency contact information and medical info such as diagnosis, allergies etc.

How to customize the template?

A patient demographic form template can help you get started collecting demographic information about your patients. Start with our pre-made form sample, which asks for info such as name, birthdate, marital status, race, contact info and more. Then customize the template to gather any other information you need in single- or multiple-choice questions, dropdown menus and more. Understanding patient demographics can help you serve your patient population better. In addition to customizing form fields, you can also change the form look and feel with pre-designed themes or your own custom CSS.

How to publish the template?

Publish your patient demographic form to your website or social media presence, or send a link to patients by email. For full optimization, connect your form to your web publishing platforms, such as Facebook, Joomla, Blogger or WordPress, so you can easily publish form information to your existing web presence and give easy access to patients. Forms are mobile friendly so patients can fill them out from anywhere, even the waiting room.

How to collect and manage data

Gather patient demographic data from your demographic data form and store it securely in an online dashboard, or export the information to Excel, CSV or PDF files. Even better, connect your patient demographic data form to the other systems you use to run your medical practice – check our 30+ integrations, so you can securely connect data across systems. Of course, HIPAA compliance is available upon request to help protect patient information.

How to optimize processes?

Optimize your patient demographic data workflow with instant email or SMS alerts when a patient demographic form is submitted, so you know right away that you have new information on file. Digitizing your workflow will help you process patient demographic data successfully.

Grab this template now