Doctor appointment form template

Need to see a doctor?What's your first name?And your last name?Okay {{field:01F7979EBBPK01D51D2JJ7GA9R}}. Is this going to be your first visit, or are you already a patient of ours?

It's my first time, I've been here before

Can you briefly describe the reason you're booking an appointment?This way, we can prepare to help you more efficiently. What day works best for you, {{field:01F7979EBBPK01D51D2JJ7GA9R}}?We'll send you an email address to confirm your appointment. Where to?Please leave your phone number in case we need to call you about last-minute changes to your appointment.Thanks {{field:01F7979EBBPK01D51D2JJ7GA9R}}. We'll see you on {{field:c6d578e2-d1aa-4841-9665-7fd6f5a5ec93}}.

Collect up to 3.5x more data with Typeform

Just what the doctor ordered for stress-free scheduling

Keep things running smoothly around the doctor’s office, all thanks to a typeform. This template shows you how easy it can be for your patients to book an appointment. Meanwhile, integrations behind it take care of things like automatic scheduling.

With Typeform, you can customize everything

Change text, colors, and even logos to match the look and feel of your brand. Then embed forms smoothly onto web and email.

Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.

Stay efficient by connecting forms to your workflow. Typeform integrates with 120+ tools including Slack, Zapier, and HubSpot.

Doctor appointment form FAQs:

They can book an appointment in a matter of seconds. This doctor appointment form works on any device, so patients can even fill it out on the go.

It’s easy to use, showing only one question at a time on the screen. Patients can briefly indicate the reason for their visit, pick a date that fits them, then wait for you to send their appointment time via email—all without having to call up or wait on hold.

Our integrations help you automate a lot of the busywork around scheduling. Hook this doctor appointment form up with apps like Arrangr and watch how booking, reserving and cancelling is all managed automatically.

It goes beyond administration, though. If you ask patients to describe their issues in the form, your doctors know beforehand what they’re dealing with. That way, everyone comes to the table well-prepared.

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.