New Patient Enrollment Form

Make the registration process as quick and simple as possible with MightyForms' convenient New Patient Enrollment Form. Easily create a magnificent enrollment form from scratch using our simple drag-and-drop editor, or build your own based on this customizable template to seamlessly collect patient personal information, their medical history details, contact data, emergency contact numbers, and anything else that you think is important. Modify your Patient Registration Form design by changing its fonts and colors, adding fields, images, and even your logo without any coding to make it look harmonious on your site. We also offer you an extensive library of various integrations that you can set up in minutes to register patients faster, keep better track of your cases, and guarantee a better patient experience overall.

Design & Personalize

Use this free template and customize your Application Forms anyway you like. With MightyForms’ drag & drop editor, you can easily add, edit and delete a variety of fields. Include your logo and the colors and theme of your choosing. Any edit you make to the theme of the form is saved to your account, so you can use it on other forms. Add a personalized pop-up or confirmation e-mail to your respondents.

Publish & Integrate

Publish your Application Forms with a click of a button. Just copy and paste the code to embed it on a website, send it to an email list or share it over social media. You can integrate your Application Forms with Google Tag Manager and Google Analytics, that way you can more easily keep track of how well it is performing. You can also integrate your form with thousands of apps through Zapier.

Collect & Share

Keep track of real-time results and views of your forms right on your MightyForms account. Our templates are 100% responsive, so your respondents can fill out your Application Forms from any device. Edit existing entries and download the reports anytime. You can also customize notification emails to be sent to you and members of your team, optimizing your workflow and keeping everyone on the same page.

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