Enable new and established patients to request appointments online with our free appointment request form template.

In addition to the patient facing fields, it also includes an additional section for staff to keep a log of contacts made with the patient to schedule their appointment. Quickly brand the form with your logo and style using our Organization Theme feature and easily embed the form onto your website, so your patients don’t have to leave your site to complete their request.

Ensure all data collected is made HIPAA compliant, by signing up for our Enterprise plan and after signing our Business Associates Agreement (BAA). Additionally, our data encryption capabilities can help ensure your data is secure at rest and in transit.

With this powerful appointment request workflow:

• Patients submit appointment requests with their usual day of week and time of day availability. The request is automatically placed in the “New Request” workflow status.
• Staff log when any contacts are made, the method of contact, and any notes regarding the attempt. After the first attempt is logged the request will be moved to the “In Progress” workflow status.
• If the patient schedules their appointment, staff will check the box for this task, indicate the date of the appointment, and the request will be moved to the “Scheduled” workflow status.
• If the patient requests to not call them again, staff will check the box for this, and the request will be moved to the “Do Not Call” workflow status.
• If staff members have made multiple contact attempts to no avail, they can indicate this by checking the box and then the request will be moved to the “Request Closed” status.

Use our Entries page and workflow statuses to easily keep track of the status of each request throughout the process.

Workflow