Initial visit patient forms

Get detailed information about your patient's medical history using this simple and convenient form. You can edit, supplement and modify existing fields, set up appointment dates and times.

Developed by: FormDesigner
Available in the tariff: Gold
Free test period of 7 days
No link to the FormDesigner website Yes
Forms
Upload storage 2 GB
Pages per form 25
Fields per form 30
Submissions 5000
Form Designer Yes
Anti-spam protection Yes
Adding custom CSS Yes
What to do with this template
 
– Create your web form from this template
– Edit, create and delete the desired elements of this web form
– Customize the design theme of your web form
– Publish on the site and receive submissions
– Analyze results and increase income
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Our benefits

Suitable for any site

Our forms work on any site and do not depend on the platform on which it is made

More than 30 different elements

To create forms of any complexity

Logical rules and branching

Show only the required fields and pages of the form, depending on customer responses

Rules for redirections

Redirect the user to different pages, depending on their responses, after submitting the form

Online payment module

Accept online payment from customers after submitting a form

Appearance

Customize different form themes to match your website design

Saving UTM tags

Automatic saving of all UTM tags on the form page is supported

Auto-complete data from a URL or cookie

Pass additional customer data to the form via a URL or cookie

Personalized and reactive forms

Address the customer by his name in the form, using substitution macros

Print page

Redirect the user to the page to print with the specified template, with the ability to save the result in PDF

Autosave data in the form

When you visit the site again, the required fields in the form will be automatically filled in

Don't lose data from blank forms

Allows you to save data even if the client did not press the "Send" button

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