Patient Information Form


What is a patient information form?

A patient information form can be of two types: New and Recurring. This form is usually used by the staff or admin at a medical practice when a patient calls to book an appointment. If the person calling is a new patient the form would include details such as the patient’s name, contact information, the reason for calling, the result of calling, and the scheduled appointment date. If the caller is a recurrent patient, the information in the form would be different.

What information does the patient information form contain?

The patient information form (new) contains the following information:
1. Patient’s name
2. Patient’s contact details
3. The reason for calling
4. Result of calling
5. Scheduled appointment date, if any.

Why is a patient information form important?

A patient information form is important because it allows your front office staff to record the information about a potential patient calling your practice for an inquiry. It’s essential to note down this information so you can follow up with this patient regarding their inquiry. Obtaining their contact information will enable you to send the patient information such as appointment reminders, scheduling appointments, general information etc.

Who fills out a new patient information form?

A new patient information form is usually filled by the front office staff who attends to the new patient’s initial call to the medical practice.