COVID-19 Suspected Patient Intake Form

Patients with suspected COVID-19 symptoms can report them online through our free suspected patient intake form. Customize the form with your practice’s logo, collect multiple emergency contacts using repeating sections, and add or change questions to your liking. Set the form’s notifications to automatically alert the appropriate systems or staff members whenever a form is submitted. Please note that our Enterprise plans can be made HIPAA compliant.

COVID-19 Suspected Patient Intake Form

Patients with suspected COVID-19 symptoms can report them online through our free suspected patient intake form.

Use This Template