Use This Template

Appointment Request

Enable new and established patients to request appointments online with our free appointment request form template. Simply customize the template to reflect your organization’s branding, and add or change any fields to work with your appointment scheduling system. Set the form’s notifications to automatically alert the appropriate systems or staff members whenever a request is submitted. Then embed it on your website to begin having patients request appointments online. Please note that our Enterprise plans can be made HIPAA compliant.

Appointment Request

Use our free appointment request form template to enable patients to request appointments online. Customize it with your branding, and embed it on your website.