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Suspected COVID-19 Patient Intake Form

Suspected COVID-19 Patient Intake Form

Create a seamless intake process for suspected coronavirus patients with this easy-to-use COVID-19 intake form template.
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Simplify your workflows

Streamline the intake of suspected coronavirus patients with Formstack’s COVID-19 patient intake form. This template includes fields that can help you gather patient information such as insurance details, COVID-19 specific symptoms, and emergency contacts.

Optimize your process

This COVID-19 intake form template is 100% customizable. With the help of Formstack’s drag-and-drop builder, it will only take you a few minutes to add your branding and tweak the form to better fit the needs of your organization.

Create a contactless experience

Keep patients and staff safe with a contactless experience. Easily embed this intake form on your website, share it with patients via email, or collect data using an in-office tablet. Formstack’s mobile-optimized forms make it easy to gather information from any device.

Meet compliance standards

Formstack offers HIPAA-friendly features that can help you achieve compliance. Safely collect sensitive patient data with security measures that include advanced data encryption, user-level permissions, audit logging, and dedicated security maintenance.

Easily set up integrations

Connect your COVID-19 intake form template to the tools your team uses every day. With dozens of integrations to choose from, you can send information to spreadsheets, route data to an outside cloud storage platform, collaborate in Salesforce, and much more.

Using Formstack, we were able to quickly deploy an e-assessment tool to virtually triage and assess patients who are unable to access care. It has been essential in helping our clinic continue to provide care during the pandemic.
Dr. Ike Ahmed
Medical Director at Prism Eye Institute

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Discover the power of turning data into dynamic action with low-code application building from Formstack.

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