Health Care Forms
Health care form templates that any medical institution can use without coding. Select from our medical forms the template that you need and customize it on 123FormBuilder. Register patients, create medical health records, simplify doctor-patient communication, and more. We also provide HIPAA-compliant forms, upon request.
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Ambulance Checklist Form
This is an online ambulance checklist form that your staff may use from any device that...
Preview templateAmbulance Transfer Form
Book ambulance transfers with this form template whenever a physician needs to transpor...
Preview templateAuthorization for Disclosure of Protected Health Information
Share this authorization for disclosure of protected health information with your patie...
Preview templateBlood Donation Form
Register blood donors that want to donate blood at your clinic. You can edit this blood...
Preview templateBody Measurement Form
Add this body measurement form template to your website with 123FormBuilder. Edit the t...
Preview templateBotox Consent Form
A handy form sample you can easily adapt to collect a brief medical history and patient...
Preview templateCancel Appointment Form
Make it much easier for patients to cancel their appointments at your office with this ...
Preview templateCaregiver Consent Form
Create and personalize a caregiver consent form using our friendly online template to a...
Preview templateChild Assessment Form
If you are the owner of an early childhood center, add this child assessment form to yo...
Preview templateChild Care Authorization Form
Edit in minutes this child care authorization form template to offer a quick way for es...
Preview templateChild Care Emergency Form
Use this child care emergency form in your clinic for parents whose children have medic...
Preview templateChild Health Survey
Quickly collect opinions on the child healthcare services in your country with this eas...
Preview templateChild Intake Form
Offering therapy services for children requires in depth documentation and valid parent...
Preview templateChiropractic Intake Form
Add this chiropractic intake form template to your website with 123FormBuilder. Edit th...
Preview templateClaim Information Form
Enhance health care services with easy-to-fill and secure medical forms. Modify this cl...
Preview templateClient History Form
A client history form will help you know better your patients before signing them up fo...
Preview templateCosmetic Surgery Survey
Find out what's the level of satisfaction of your patients with this cosmetic surgery s...
Preview templateDental Assessment Form
The oral health center you run would greatly benefit from this modifiable dental assess...
Preview templateDental Assistant Evaluation Form
This pre-made form sample helps externship supervisors to quickly assess the activity o...
Preview templateDental Claim Form
Share this dental claim form with your patients to improve your dental services, optimi...
Preview templateDental Clearance Form
Simplify dental clearance requests for your clinic prior to transplant surgeries with t...
Preview templateDental Enrollment Form
Quickly collect employee data to enroll them in a dental health care plan. You don’t ne...
Preview templateDental Estimate Form
Provide dental patients with an online tool to request an estimate regarding their dent...
Preview templateDental Examination Form
Using this dental examination form for your school’s health program will greatly simpli...
Preview templateDental Implant Consent Form
Use this dental implant consent form in your dental clinic. It's easy to adapt it to yo...
Preview templateDental Insurance Breakdown Form
There's no effort or technical knowledge involved in customizing this dental insurance ...
Preview templateDental Insurance Form
Share this dental insurance form with your patients to improve your dental services, op...
Preview templateDental Insurance Verification Form
It's easy to use this online dental insurance verification form in your practice. Just ...
Preview templateDental Procedure Medical History Form
Share this dental procedure medical history form with your patients to improve your med...
Preview templateDental Records Release Form
Use this form when disclosing certain dental records with the patient’s consent. Custom...
Preview templateDental Referral Form
Edit and use this modifiable template for a referral that can be faxed or securely emai...
Preview templateDental Reimbursement Form
Offer employees a handy method to request reimbursement for the dental treatments they ...
Preview templateDental Screening Form
Quickly collect dental screening info for children with this form sample you can easily...
Preview templateDental Treatment Consent Form
Create a dental treatment consent form in minutes with this straightforward and coding-...
Preview templateDental Treatment Plan Form
Use this digital dental treatment plan in your practice to better organize records and ...
Preview templateDentistry Contact Form
Share this dentistry contact form with your patients to improve your medical services, ...
Preview templateDisability Verification Form
Provide healthcare professionals with an online form to assess student disabilities and...
Preview templateDoctor Appointment Form
Customize this doctor appointment form template in any way you want and use it in your ...
Preview templateDoctor Diagnosis Form
Create records of patient diagnoses after each appointment by filling in this doctor di...
Preview templateDoctor Referral Form
Add this doctor referral form template to your website with 123FormBuilder. Edit the te...
Preview templateDrug Prior Authorization Request Form
Share this drug prior authorization request form with your patients to improve your med...
Preview templateElectronic Claim Form
Adapt this ready-to-go electronic claim form sample to match your practice. You don't n...
Preview templateEmergency Contact Form
Use this emergency contact form to register contact information of a person close to yo...
Preview templateEmergency Information Form
You can use this emergency information form template to create records of medical condi...
Preview templateEndodontist Patient Registration Form
Register patients to your endodontist medical office with the help of this endodontist ...
Preview templateEndodontist Referral Form
Share this endodontist referral form with your patients to improve your medical service...
Preview templateEnrollee Prescription Drug Claim Form
Share this enrollee prescription drug claim form with your patients to improve your med...
Preview templateFacial Intake Form
Use this facial intake form template in your beauty salon, configure it and publish it ...
Preview templateFirst Aid Checklist Form
Edit this sample first aid checklist form and share it within your organization. No cod...
Preview templateFirst Aid Quiz
Test first aid knowledge with this ready-to-go online quiz template. Add more questions...
Preview templateFlu Vaccine Consent Form
Share this form with your patients before providing them the vaccine. Edit this flu vac...
Preview templateFood Allergy Form
Learn about the food intolerances of students with an online food allergy form sample t...
Preview templateGeneral Dentist Patient Registration Form
Share this general dentist patient registration form with your patients to improve your...
Preview templateGeneral Surgery Consent Form
Patient consent before surgical procedures is a must. Simplify your administrative work...
Preview templateHealth Assessment Questionnaire
Share this health assessment questionnaire with your patients to measure outcomes of ce...
Preview templateHealth Checklist Form
If you own a veterinary clinic, provide pet owners with this easy-to-fill pet health ch...
Preview templateHealth Evaluation Form
Add this health evaluation form template to your website with 123FormBuilder. Edit the ...
Preview templateHealth Insurance Claim Form
Use this health insurance claim form to receive online reimbursement requests or direct...
Preview templateHealth Insurance Evaluation Survey
Add this health insurance evaluation survey template to your website with 123FormBuilde...
Preview templateHealth Insurance Information Form
Edit this health insurance information form example in any way you want with 123FormBui...
Preview templateHealth Insurance Marketplace Statement
Simplify record keeping and make tax time easier with this health insurance marketplace...
Preview templateHealth Screening Form
Use our digital template to gather health info about people who join your physical trai...
Preview templateHealth Survey
Add this health survey template to your website and modify it as you see fit. You can u...
Preview templateHome Delivery Pharmacy Prescription Order Form
Share this home delivery pharmacy prescription order form with your patients to improve...
Preview templateHospital Admission Form
Use this hospital admission form template in your organization, tune it up as needed an...
Preview templateHospital Discharge Form
Use this hospital discharge form template in your practice, tune it up as needed and pu...
Preview templateHospital Evaluation Form
Use this hospital evaluation form template in your organization, tune it up as needed a...
Preview templateHospital Patient Satisfaction Survey
With this easy customizable patient satisfaction survey template, you can make sure the...
Preview templateHospital Registration Form
You can use this hospital registration form to capture patient information online. Modi...
Preview templateHospital Visitation Form
Ensure hospital visitors have good experiences while registering. This ready-made hospi...
Preview templateImmunization Exemption Form
Share this form with individuals that require a medical exemption to immunization or an...
Preview templateImmunization Record Form
Keep an electronic record of your patients’ immunizations with this immunization record...
Preview templateImmunization Record Request Form
Authorize the release of immunization records with the help of a friendly online form. ...
Preview templateImmunization Waiver Form
Customize this immunization waiver form template on 123FormBuilder and publish it anywh...
Preview templateIndemnity Form
This medical consent and indemnity form sample is useful to collect data from participa...
Preview templateInformed Consent Form
Are you performing a clinical research study? Then this informed consent form template ...
Preview templateLaboratory Test Request Form
Receive laboratory test requests by email with this form template. Customize the labora...
Preview templateMassage Consent Form
Make sure your massage therapy customers are well informed before taking in the benefit...
Preview templateMassage Health History Form
Learn a bit about each patient and ensure it's safe for them to receive massage therapy...
Preview templateMassage Therapy Consent Form
Customize this massage therapy consent form template in any way you want and publish it...
Preview templateMassage Therapy Intake Form
This is a client intake form template that you may use for massage therapy. Customize t...
Preview templateMaternity Claim Form
You can modify anything you want in this claim form for lead maternity carer. No need f...
Preview templateMedicaid Application Form
If you're working for an agency that is part of the Medicaid program for low-income and...
Preview templateMedicaid Complaint Form
Customize this medicaid complaint form with simple clicks and paste it instantly with t...
Preview templateMedicaid Transportation Form
Customize this medicaid transportation form template with simple drag & drop and other ...
Preview templateMedical Card Application Form
Use this medical card application form to receive all your requested information from y...
Preview templateMedical Consultation Form
Gather enough patient information that will help with the live consultation.
Preview templateMedical Declaration Form
If you work for an education provider, go ahead and use our ready-made declaration form...
Preview templateMedical Examination Form
You can use this form template to register patients for a medical exam within your clin...
Preview templateMedical Examination Report Form
Conduct medical consultations with more ease with the help of a digital medical examina...
Preview templateMedical History Form
Use this medical history template at your clinic to complete patient records and file u...
Preview templateMedical Information Form
No headaches involved in customizing this medical information form sample. Reinforce it...
Preview templateMedical Insurance Form
Provide people an online form to apply for insurance coverage. Take this ready-made med...
Preview templateMedical Order Form
Add this medical order form template to your website with 123FormBuilder. Edit the tem...
Preview templateMedical Permission Form
Easily custom and share this medical permission form template to allow parents or other...
Preview templateMedical Record Transfer Request
Share this medical record transfer request with your patients to improve your medical s...
Preview templateMedical Records Release Form
Add this medical records release form template to your website with 123FormBuilder. Edi...
Preview templateMedical Records Request Form
Add this medical records request form template to your website with 123FormBuilder. Edi...
Preview templateMedical Reimbursement Bill Form
With this medical reimbursement bill form, you can collect the data that you need in no...
Preview templateMedical Reimbursement Claim Form
This is a medical reimbursement claim form that you may use in your organization. Set i...
Preview templateMedical Release Form
Receive authorization from the parents or legal guardians of minors before providing t...
Preview templateMedical Summary Form
Offer your patients a quick way to submit their medical history with our medical summar...
Preview templateMedical Travel Form
Provide patients with an online travel form that will help you collect important data. ...
Preview templateMedicare Application Form
Offer a quick and easy method for people to apply for Medicare benefits. Customize it a...
Preview templateMedication Administration Record
Share this medication administration record with your patients to improve your medical ...
Preview templateMedication Disposal Form
Use our thorough medication disposal form to efficiently manage the situation of unused...
Preview templateMedication List Form
This is an online personal medication list form template that can be used by any patien...
Preview templateMember Reimbursement Form
Use this stress-free family member reimbursement form template to help you claim refund...
Preview templateMental Health Intake Form
Add this mental health intake form template to your website with 123FormBuilder. Edit t...
Preview templateMental Health Survey
Understand how young people handle the high school stress with a mental health survey. ...
Preview templateNewborn Questionnaire
Use this newborn questionnaire template in your organization, tune it up as needed and ...
Preview templateNursing Assessment Form
An easy to modify and publish nursing assessment form to use for schools or health cent...
Preview templateNursing Home Application Form
Use this nursing home application form template in your organization, tune it up as nee...
Preview templateNutrition Consultation Form
Add this nutrition consultation form template to your website with 123FormBuilder. Edit...
Preview templateOccupational Therapy Progress Note
Writing down patient info is a thing of the past. Use our HIPAA-compliant occupational ...
Preview templateOnline Bill Payment
Share this online bill payment with your patients to improve your medical services, opt...
Preview templateOnline Medical Questionnaire
This is a generic online medical questionnaire template that you may use to learn more ...
Preview templateOphthalmology Referral Form
Your ophthalmology practice could truly benefit from adding this easy-to-customize refe...
Preview templateOral Surgery Consent Form
Modify this oral surgery consent form with 123FormBuilder and make it available on a ta...
Preview templateOral Surgery Patient Registration Form
Share this oral surgery patient registration form with your patients to improve your me...
Preview templateOral Surgery Referral Form
Share this oral surgery referral form with your patients to improve your medical servic...
Preview templateOrgan and Tissue Donation Form
Share this organ and tissue donation form with people that are interested in donating t...
Preview templateOrgan Donation Form
Share this organ donation form with people that are interested in donating their organs...
Preview templatePathology Request Form
Receive pathology test request directly online with this easy-to-use form template. Cus...
Preview templatePatient Admission Form
This patient admission form template may be used by your customers that need to registe...
Preview templatePatient Appointment Request Form
Share this patient appointment request form with your patients to improve your medical ...
Preview templatePatient Assessment Form
Evaluate your patients with this patient assessment form template that is easy to use a...
Preview templatePatient Demographic Form
Add this patient demographic form template to your website with 123FormBuilder. Edit th...
Preview templatePatient Discharge Form
Automate the process of discharging patients with this online form template that stores...
Preview templatePatient Engagement Survey
Measure patient satisfaction with your medical institution with this patient engagement...
Preview templatePatient Exit Survey
Add this patient exit survey template to your medical organization that you can use to ...
Preview templatePatient History Form
You can use this online form to create a record of a patient's medical history. It is c...
Preview templatePatient Intake Form
This is a secure online patient intake form that you may send to your customers. Create...
Preview templatePatient Monitoring Form
Monitor your patients in a professional manner with this easy-to-use form template. Mod...
Preview templatePatient Note Entry Form
Use this online patient note entry form template in your organization. Doctors may fill...
Preview templatePatient Nutrition Assessment Form
Evaluate the nutrient intake and lifestyle of your patients with this online nutrition ...
Preview templatePatient Pain Assessment Form
You can modify this patient pain assessment form template as you see fit and use it to ...
Preview templatePatient Progress Tracking
Share this patient progress tracking with your patients to improve your medical service...
Preview templatePatient Registration Form
Use this patient registration form template to collect personal patient information onl...
Preview templatePatient Revocation Request Form
Share this change/revoke request with your patients to improve your medical services, o...
Preview templatePatient Satisfaction Survey
Evaluate your medical services with this satisfaction survey that you can share with your patients.
Preview templatePatient Survey Questionnaire
Add this patient survey questionnaire to your medical organization and start surveying ...
Preview templatePediatric Consent Form
This form template can be filled in by parents or guardians to authorize the use of med...
Preview templatePedodontic Patient Information Form
Share this pedodontic patient information form with your patients to improve your denta...
Preview templatePeriodontal Referral Form
Share this periodontal referral form with your patients to improve your medical service...
Preview templatePermission To Treat Form
Offer parents a friendly way to express consent for their child's medical treatments by...
Preview templatePersonal Representative Request
Share this personal representative request with your patients to improve your medical s...
Preview templatePharmacy Complaint Form
Add this pharmacy complaint form template to your website with 123FormBuilder. Edit the...
Preview templatePharmacy Registration Form
Register pharmacist that want to obtain a license, with the help of this online form te...
Preview templatePhysical Clearance Form
Modify this physical clearance form in the 123FormBuilder editor without worrying about...
Preview templatePhysical Exam Form
This physical exam form template is a great help for health providers. Adapt it to your...
Preview templatePhysical Therapy Evaluation Form
With this physical therapy evaluation form template, you can optimize your internal pro...
Preview templatePhysician Referral Form
Receive referral or consultation requests online with the help of this physician referr...
Preview templatePhysician Satisfaction Survey
Let your patients complete a physician satisfaction survey from time to time, in order ...
Preview templatePhysician Verification Form
Use this physician verification form sample to validate patient diagnosis and certify m...
Preview templatePolice Medical Questionnaire
Share this medical questionnaire within your police force to assess the health conditio...
Preview templatePrescription Drug Claim Form
Share this prescription drug claim form with your patients to improve your medical serv...
Preview templatePrescription Form
Share this prescription form with patients to improve your medical services, optimize y...
Preview templatePrescription Refill Request Form
Share this prescription refill request form with your patients to improve your medical ...
Preview templateProof Of Immunization Form
Here's a vaccination record form sample for a history of all the vaccines received. Cus...
Preview templateProvider Satisfaction Survey
Measure your patients' healthcare experience with a ready-made provider satisfaction su...
Preview templatePsychiatric Evaluation Form
Add this psychiatric evaluation form template to your website with 123FormBuilder. Edit...
Preview templatePsychological Assessment Form
Clone this psychological assessment form template to your 123FormBuilder dashboard and ...
Preview templatePsychology Intake Form
Use this client intake form sample within your practice to assess patient history and l...
Preview templatePsychology Referral Form
Simplify medical referrals by using an online psychology referral form template. You ca...
Preview templatePsychotherapy Intake Form
Gather patient information for psychotherapy session as easy as 1-2-3. No coding needed...
Preview templateReferral Request Form
Need a medical referral form sample to add to your website? Modify the request template...
Preview templateRequest a Routine Medical Appointment
Share this request a routine medical appointment with your patients to improve your med...
Preview templateRequest for Access to Protected Health Information
Share this request for access to protected health information with your patients to imp...
Preview templateRequest for Accounting
Share this request for accounting with your patients to improve your medical services, ...
Preview templateRequest for Confidential Communications
Share this request for confidential communications with your patients to improve your m...
Preview templateRequest for Diagnosis and Treatment Code Information Form
Share this request for diagnosis and treatment code information form with your patients...
Preview templateRequest for Restriction of Use and Disclosure of PHI
Share this request for restriction of use and disclosure of protected health informatio...
Preview templateRequest Routine Dental Appointment Form
Share this request routine dental appointment form with your patients to improve your m...
Preview templateRequest to Amend Protected Health Information
Share this request to amend protected health information with your patients to improve ...
Preview templateRequest to Inspect a Copy of Clinical Record
Share this request to inspect a copy of clinical record with your patients to improve y...
Preview templateRequest to Obtain a Copy of Clinical Record
Share this request to obtain a copy of clinical record with your patients to improve yo...
Preview templateRequest to Restrict the Use of Confidential Information
Share this request to restrict the use of confidential information with your patients t...
Preview templateSafety Declaration Form
This health and safety declaration form sample is helpful if you host ample events, in ...
Preview templateSchool Entry Health Form
Create a record of each student's health history and medical conditions from your school.
Preview templateSchool Medication Form
Share this school medication form with your students to optimize and digitize your inte...
Preview templateSchool Medication Record
Share this school medication record with your students to optimize and digitize your in...
Preview templateSelf Referral Form
If you run a maternity, offer soon-to-be mothers the option to self-refer to a midwife....
Preview templateSocial Psychology Survey
Use this prebuilt social psychology survey as a starting point to create your own frien...
Preview templateSocial Work Intake Form
We provide you with a pre-built and easy-to-use social work intake form template. Modif...
Preview templateSports Physical Form
Add this sports physical form template to your website with 123FormBuilder. Edit the te...
Preview templateSports Therapy Consultation Form
Use an online sports therapy consultation form in your practice to simplify client enro...
Preview templateStatement of Disagreement
Share this statement of disagreement request to forward denial of amendment request wit...
Preview templateStudent Health Record Form
Keeping track of sensitive medical data for students is no longer a challenge. Easily e...
Preview templateStudent Insurance Claim Form
Customize this student insurance claim form template in any way you want with 123FormBu...
Preview templateTest Report Form
Report test results with the help of this test report form template. It can be used in ...
Preview templateTherapy Consent Form
Allow your patients to consent to any therapeutic services you provide by using an onli...
Preview templateTraining Requirement Form
Offer healthcare providers an online form to apply for notifications about upcoming tra...
Preview templateTreatment Consent Form
Ask your patients for permission for diagnosis and treatment with an online treatment c...
Preview templateUniversal Medication Form
Share this universal medication form with your patients to improve your medical service...
Preview templateVaccine Order Form
Add this vaccine order form template to your website with 123FormBuilder. Edit the temp...
Preview templateVeterinary Prescription Form
Add this veterinary prescription form template to your website with 123FormBuilder. Edi...
Preview templateVeterinary Release Form
Provide instructions and offer your customers an easy way to submit a vet release, by m...
Preview templateWeight Loss Tracking Form
Here's an easy way to enter your weight loss goals and track daily progress. This form ...
Preview templateWound Assessment Form
Our ready-to-go wound assessment form allows field nurses to quickly and effortlessly d...
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