Collect requests and feedback at any time with forms that patients can fill out online. Get the information you need with less hassle than paper forms.

Healthcare Forms

Cognito Forms can help your business get:

  • Appointment requests
  • Emergency contact forms
  • Patient surveys
  • Prescription refill requests
  • Medical record requests

Example Prescription Refill Form

Scenario: In healthcare, promptness is key. Dr. Mohammad won’t be losing any more patience now that his staff can get prescriptions refilled quickly.

Form & Function

Cognito forms respond to screen size, boast repeating sections and wield conditional logic.

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Repeating sections

Repeating Sections

Save & Resume

Save & Resume

Payment Forms

Stripe for Payment