Hospital Admission Form Template

Benefits of using this Hospital Admission Form Template

Personalize the form

Make this hospital admission form concise and give a touch of personalization with skip/display logic. Make the question appear based on the previous response. For example, if your patient chooses consultation under a specific department, then redirect them to questions related to only those physicians who are specialized in that department. This makes the form shorter avoiding asking unnecessary details. Use custom params to call the patient’s name during the form.

130+ Languages Supported

Translate this form template with the builder using Google Translate feature. The built-in translator allows you to choose almost any global language and translate the form instantly. Once the translation is done, preview the form, and make the necessary changes.

Get a Printable Hospital Admission Form

Our platform allows hospitals to take printouts of this patient admission form. Paper forms are useful during emergency situations as there is no dependency on an internet connection. The form can be filled out anywhere. Our form builder also provides different orientation options and paper sizes for better presentation. Customize the printed form with your logo in the footer.

Get Instant Notifications

SurveySparrow sends email notifications to your inbox for every patient admission made. You can also configure the notifications in such a way that the respective doctor gets a notification every time a patient is admitted. The real-time notification feature helps promptly acknowledge patient admittance and respond quickly to any emergency cases.

Try these templates

• Patient Waiting Form Template
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How this Hospital Admission Form Template complies with HIPAA guidelines

• Role-based access control - Multi-layered access control for owner, admin, and contributors. The admin has complete control of the account and the users, with features such as roles & access.
• Encryption - All data is encrypted in transit, end to end, and at rest using industry-standard Advanced Encryption Standard (AES) encryption using 256-bit keys to protect data encryption.
• Two-factor authentication - With the 2-factor authentication, users require the security code to log in to the SurveySparrow account. Even if someone finds your password, they cannot log in without your security code.
• Person or Entity Authentication - SurveySparrow has a policy that describes the process of verifying a person’s identity before unlocking their account, resetting their password, and/or providing access to ePHI.

How to use this hospital admission form template?

Step 1: Customize

Scroll up, click on ‘Use this Template’, and sign up to customize this sample hospital admission form. Change the background, and font. Personalize the welcome and thank-you pages according to your choice. Need text inspiration? Let AI Wings rephrase questions or descriptions!

Step 2: Integrate with Third Party Apps

SurveySparrow supports 20+ native integrations like Google Sheets, Mailchimp, Hubspot etc, and 1000+ through Zapier. Create workflows to streamline patient admissions, export data into spreadsheets, and do more!

Step 3: Share

Whether it’s through a unique link, website embed, email invite, or a QR code, our platform offers diverse sharing options to reach your customers wherever they are.

Step 4: Results

Export responses to CSV for offline analysis and use SurveySparrow’s dashboard for segmentation and visualization. Interpret the details efficiently for further contact and treatments.