New Patient Registration

Use our free new patient registration form template to collect information from prospective patients. Customize the form with your practice’s logo, collect multiple emergency contacts using repeating sections, and add or change survey questions to your liking. Then, embed the form directly on your practice’s website and get notified via email when new registrations are submitted. Please note that our Enterprise plans can be made HIPAA compliant.

New Patient Registration

Use our free new patient registration form template to collect information from prospective patients.

Use This Template