Don't miss the future of CX at RefineCX USA!  Register Now

Don't miss the future of CX at RefineCX USA!
Templates Healthcare

Hospital Discharge Form Template

Features of Hospital Discharge Form Template

Improve patient discharge experience with this hospital discharge form template


Benefits of this Hospital Discharge Form Template


Use it Offline

Install SurveySparrow app in a tab, or kiosk and allow patients or their caretakers to access the form offline. This feature is helpful for clinics located in isolated places with no internet connection. The mobile-friendly interface of the form gives a pleasant experience regardless of the screen size.

File Upload Feature

Collect necessary discharge documents from patients through the form. The feature accepts PDFs, images, and videos as well. Once the patient uploads a file, you can access it in the dashboard. This also helps in centralized record management.

HIPAA Compliant

There is no question of worrying about your patients’ information. The form is HIPAA-compliant and every information collected remains safe and secure. Our HIPAA-compliant form builder allows patients access to the information, and only authorized personnel can access it.

Two Formats

The form can be used either in a conversational style, where one field appears per screen, or, as a single-page form. The latter one is a more traditional approach, but the conversational style enhances the form-filling experience.

Draw, Type, or Upload Signature

Patients or their caretakers can digitally sign the form. You can use signature-type questions from our builder. You can choose between draw, type, or upload options. Patients can draw the signature using the touch, type it out, or upload a digital signature.

Suggested Template: Patient Information Form Template


How to use this template?


Have you gone through the preview? If yes, you just need to click on the “Use This Template” button the template will open in your builder. You can follow these four steps to start using your personalized hospital discharge form,

Step 1: Customize

Start with customizing the form based on your needs. Use drag and drop builder t change the sequence of questions. Edit the questions, add more or remove the ones you don’t need. Change the background either by uploading an original image or using one from the inbuilt Unsplash image gallery.

Step 2: Integrate

If needed, connect the form with third-party apps listed in the integration tab. In this case, Google Sheets integration comes in handy. When you toggle ON this integration, all the discharge information will be instantly recorded into a sheet. This will help you to have a single database of all discharge information. You can explore other integrations as well.

Step 3: Share

The form can be shared through more than 20 different channels. Other than direct sharing link, you can also share the form as a QR code, SMS, WhatsApp, embed it in an email, or embed it in a webpage. For all these, you need not have coding knowledge. The platform will generate shortcodes for you for direct usage.

Step 4: Result

Check all the responses in the results area. You can export them into a PDF or CSV and sort them based on your preference. You can also use our dashboard to understand patient demographics, and illness and use this information to provide better care.


Tips to use this template effectively


  • Add your hospital or clinic logo on the welcome screen, and change the button, background and font colors to match your brand.
  • Use AI wing feature of our builder to reframe the content inside the form. Choose the right tone and connect with your patients.
  • Enable “resubmit responses” in settings so that respondents can make corrections to the details even after the form is submitted.
  • Use CSS editor to code the form background. You can create anything you imagine!
  • Use the scheduling feature to streamline communication with the patient. This feature is useful when the patient’s discharge date is already known.
  • Export the PDF version of the form and use it in a printable format.

See it, to believe it.

Try for free