Health Care Forms

128 templates

Health care form templates that any medical institution can use without coding. Select the medical form template that you need and customize it on 123FormBuilder. Register patients, create medical health records, and more. We also provide HIPAA-compliant forms, on request.

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Ambulance Checklist Form

This is an online ambulance checklist form that your staff may use from any device that...

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Ambulance Transfer Form

Book ambulance transfers with this form template whenever a physician needs to transpor...

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Authorization for Disclosure of Protected Health Information

Share this authorization for disclosure of protected health information with your patie...

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Blood Donation Form

Register blood donors that want to donate blood at your clinic. You can edit this blood...

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Body Measurement Form

Add this body measurement form template to your website with 123FormBuilder. Edit the t...

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Cancel Appointment Form

Make it much easier for patients to cancel their appointments at your office with this ...

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Caregiver Consent Form

Create and personalize a caregiver consent form using our friendly online template to a...

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Chiropractic Intake Form

Add this chiropractic intake form template to your website with 123FormBuilder. Edit th...

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Dental Claim Form

Share this dental claim form with your patients to improve your dental services, optimi...

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Dental Insurance Form

Share this dental insurance form with your patients to improve your dental services, op...

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Dental Procedure Medical History Form

Share this dental procedure medical history form with your patients to improve your med...

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Dental Records Release Form

Use this form when disclosing certain dental records with the patient’s consent. Custom...

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Dental Referral Form

Edit and use this modifiable template for a referral that can be faxed or securely emai...

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Dentistry Contact Form

Share this dentistry contact form with your patients to improve your medical services, ...

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Doctor Appointment Form

Customize this doctor appointment form template in any way you want and use it in your ...

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Doctor Diagnosis Form

Create records of patient diagnoses after each appointment by filling in this doctor di...

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Doctor Referral Form

Add this doctor referral form template to your website with 123FormBuilder. Edit the te...

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Drug Prior Authorization Request Form

Share this drug prior authorization request form with your patients to improve your med...

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Emergency Contact Form

Use this emergency contact form to register contact information of a person close to yo...

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Endodontist Patient Registration Form

Register patients to your endodontist medical office with the help of this endodontist ...

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Endodontist Referral Form

Share this endodontist referral form with your patients to improve your medical service...

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Enrollee Prescription Drug Claim Form

Share this enrollee prescription drug claim form with your patients to improve your med...

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Facial Intake Form

Use this facial intake form template in your organization, configure it and publish it ...

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First Aid Checklist Form

Edit this sample first aid checklist form and share it within your organization. No cod...

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Flu Vaccine Consent Form

Share this form with your patients before providing them the vaccine. Edit this flu vac...

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General Dentist Patient Registration Form

Share this general dentist patient registration form with your patients to improve your...

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Health Assessment Questionnaire

Share this health assessment questionnaire with your patients to measure outcomes of ce...

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Health Evaluation Form

Add this health evaluation form template to your website with 123FormBuilder. Edit the ...

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Health Insurance Claim Form

Use this health insurance claim form to receive online reimbursement requests or direct...

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Health Insurance Evaluation Survey

Add this health insurance evaluation survey template to your website with 123FormBuilde...

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Health Insurance Marketplace Statement

Share this health insurance marketplace statement with your patients to improve your me...

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Health Survey

Add this health survey template to your website and modify it as you see fit. You can u...

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Home Delivery Pharmacy Prescription Order Form

Share this home delivery pharmacy prescription order form with your patients to improve...

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Hospital Admission Form

Use this hospital admission form template in your organization, tune it up as needed an...

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Hospital Discharge Form

Use this hospital discharge form template in your organization, tune it up as needed an...

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Hospital Evaluation Form

Use this hospital evaluation form template in your organization, tune it up as needed a...

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Hospital Patient Satisfaction Survey

With this easy customizable patient satisfaction survey template, you can make sure the...

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Hospital Registration Form

You can use this hospital registration form to capture patient information online. Modi...

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Immunization Exemption Form

Share this form with individuals that require a medical exemption to immunization or an...

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Immunization Record Form

Keep an electronic record of your patients’ immunizations with this immunization record...

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Immunization Waiver Form

Customize this immunization waiver form template on 123FormBuilder and publish it anywh...

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Indemnity Form

This medical consent and indemnity form sample is useful to collect data from participa...

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Laboratory Test Request Form

Receive laboratory test requests by email with this form template. Customize the labora...

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Massage Therapy Intake Form

This is a client intake form template that you may use for massage therapy. Customize t...

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Medicaid Application Form

If you're working for an agency that is part of the Medicaid program for low-income and...

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Medicaid Complaint Form

Customize this medicaid complaint form with simple clicks and paste it instantly with t...

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Medicaid Transportation Form

Customize this medicaid transportation form template with simple drag & drop and other ...

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Medical Card Application Form

Use this medical card application form to receive all your requested information from y...

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Medical Consultation Form

Gather enough patient information that will help with the live consultation.

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Medical Examination Form

You can use this form template to register patients for a medical exam within your clin...

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Medical History Form

Use this medical history template at your clinic to complete patient records and file u...

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Medical Permission Form

Easily custom and share this medical permission form template to allow parents or other...

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Medical Record Transfer Request

Share this medical record transfer request with your patients to improve your medical s...

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Medical Records Release Form

Add this medical records release form template to your website with 123FormBuilder. Edi...

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Medical Records Request Form

Add this medical records request form template to your website with 123FormBuilder. Edi...

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Medical Reimbursement Bill Form

With this medical reimbursement bill form, you can collect the data that you need in no...

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Medical Reimbursement Claim Form

This is a medical reimbursement claim form that you may use in your organization. Set i...

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Medical Release Form

Receive authorization from the parents or legal guardians of minors before providing t...

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Medication Administration Record

Share this medication administration record with your patients to improve your medical ...

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Medication List Form

This is an online personal medication list form template that can be used by any patien...

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Medicine Order Form

Add this medicine order form template to your website with 123FormBuilder. Edit the tem...

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Mental Health Intake Form

Add this mental health intake form template to your website with 123FormBuilder. Edit t...

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Newborn Questionnaire

Use this newborn questionnaire template in your organization, tune it up as needed and ...

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Nursing Home Application Form

Use this nursing home application form template in your organization, tune it up as nee...

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Nutrition Consultation Form

Add this nutrition consultation form template to your website with 123FormBuilder. Edit...

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Occupational Therapy Progress Note

Writing down patient info is a thing of the past. Use our HIPAA-compliant occupational ...

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Online Bill Payment

Share this online bill payment with your patients to improve your medical services, opt...

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Online Medical Questionnaire

This is a generic online medical questionnaire template that you may use to learn more ...

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Ophthalmology Referral Form

Your ophthalmology practice could truly benefit from adding this easy-to-customize refe...

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Oral Surgery Patient Registration Form

Share this oral surgery patient registration form with your patients to improve your me...

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Oral Surgery Referral Form

Share this oral surgery referral form with your patients to improve your medical servic...

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Organ and Tissue Donation Form

Share this organ and tissue donation form with people that are interested in donating t...

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Organ Donation Form

Share this organ donation form with people that are interested in donating their organs...

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Pathology Request Form

Receive pathology test request directly online with this easy-to-use form template. Cus...

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Patient Admission Form

This patient admission form template may be used by your customers that need to registe...

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Patient Appointment Request Form

Share this patient appointment request form with your patients to improve your medical ...

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Patient Assessment Form

Evaluate your patients with this patient assessment form template that is easy to use a...

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Patient Demographic Form

Add this patient demographic form template to your website with 123FormBuilder. Edit th...

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Patient Discharge Form

Automate the process of discharging patients with this online form template that stores...

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Patient Exit Survey

Add this patient exit survey template to your medical organization that you can use to ...

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Patient History Form

You can use this online form to create a record of a patient's medical history. It is c...

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Patient Intake Form

This is a secure online patient intake form that you may send to your customers. Create...

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Patient Note Entry Form

Use this online patient note entry form template in your organization. Doctors may fill...

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Patient Nutrition Assessment Form

Evaluate the nutrient intake and lifestyle of your patients with this online nutrition ...

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Patient Pain Assessment Form

You can modify this patient pain assessment form template as you see fit and use it to ...

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Patient Progress Tracking

Share this patient progress tracking with your patients to improve your medical service...

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Patient Registration Form

Use this patient registration form template to collect personal patient information onl...

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Patient Revocation Request Form

Share this change/revoke request with your patients to improve your medical services, o...

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Patient Survey Questionnaire

Add this patient survey questionnaire to your medical organization and start surveying ...

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Pedodontic Patient Information Form

Share this pedodontic patient information form with your patients to improve your denta...

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Periodontal Referral Form

Share this periodontal referral form with your patients to improve your medical service...

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Personal Representative Request

Share this personal representative request with your patients to improve your medical s...

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Pharmacy Complaint Form

Add this pharmacy complaint form template to your website with 123FormBuilder. Edit the...

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Pharmacy Registration Form

Register pharmacist that want to obtain a license, with the help of this online form te...

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Physical Therapy Evaluation Form

With this physical therapy evaluation form template, you can optimize your internal pro...

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Physician Referral Form

Receive referral or consultation requests online with the help of this physician referr...

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Police Medical Questionnaire

Share this medical questionnaire within your police force to assess the health conditio...

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Prescription Drug Claim Form

Share this prescription drug claim form with your patients to improve your medical serv...

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Prescription Form

Share this prescription form with your patients to improve your medical services, optim...

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Prescription Refill Request Form

Share this prescription refill request form with your patients to improve your medical ...

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Psychiatric Evaluation Form

Add this psychiatric evaluation form template to your website with 123FormBuilder. Edit...

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Psychotherapy Intake Form

Gather patient information for psychotherapy session as easy as 1-2-3. No coding needed...

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Referral Request Form

Need a medical referral form sample to add to your website? Modify the request template...

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Request a Routine Medical Appointment

Share this request a routine medical appointment with your patients to improve your med...

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Request for Access to Protected Health Information

Share this request for access to protected health information with your patients to imp...

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Request for Accounting

Share this request for accounting with your patients to improve your medical services, ...

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Request for Confidential Communications

Share this request for confidential communications with your patients to improve your m...

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Request for Diagnosis and Treatment Code Information Form

Share this request for diagnosis and treatment code information form with your patients...

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Request for Restriction of Use and Disclosure of PHI

Share this request for restriction of use and disclosure of protected health informatio...

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Request Routine Dental Appointment Form

Share this request routine dental appointment form with your patients to improve your m...

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Request to Amend Protected Health Information

Share this request to amend protected health information with your patients to improve ...

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Request to Inspect a Copy of Clinical Record

Share this request to inspect a copy of clinical record with your patients to improve y...

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Request to Obtain a Copy of Clinical Record

Share this request to obtain a copy of clinical record with your patients to improve yo...

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Request to Restrict the Use of Confidential Information

Share this request to restrict the use of confidential information with your patients t...

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School Medication Form

Share this school medication form with your students to optimize and digitize your inte...

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School Medication Record

Share this school medication record with your students to optimize and digitize your in...

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Self Referral Form

If you run a maternity, offer soon-to-be mothers the option to self-refer to a midwife....

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Sports Physical Form

Add this sports physical form template to your website with 123FormBuilder. Edit the te...

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Statement of Disagreement

Share this statement of disagreement request to forward denial of amendment request wit...

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Student Insurance Claim Form

Customize this student insurance claim form template in any way you want with 123FormBu...

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Test Report Form

Report test results with the help of this test report form template. It can be used in ...

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Universal Medication Form

Share this universal medication form with your patients to improve your medical service...

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Veterinary Prescription Form

Add this veterinary prescription form template to your website with 123FormBuilder. Edi...

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Veterinary Release Form

Provide instructions and offer your customers an easy way to submit a vet release, by m...

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