formisoft

Advance Directive Form

Asks about life-sustaining treatment preferences, cardiopulmonary resuscitation (CPR) preference, and mechanical ventilation preference. Built for hospital admission advance directive screening.

Questions
14
Page
1
Time
about 4 min

Includes

  • E-signature
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Your practice

Live preview. Tap through it like a patient.

Who it is for

  • Hospital admission advance directive screening
  • Primary care annual wellness visit documentation
  • Geriatric and palliative care patient planning
  • Surgical pre-admission advance care planning

What's inside

  1. Full NameText · Required
  2. Date of BirthDate · Required
  3. Life-Sustaining Treatment PreferencesMultiple Choice · 3 choices · Required
  4. Cardiopulmonary Resuscitation (CPR) PreferenceMultiple Choice · 2 choices · Required
  5. Mechanical Ventilation PreferenceMultiple Choice · 3 choices · Required
  6. Artificial Nutrition and Hydration PreferenceMultiple Choice · 3 choices · Required
  7. Healthcare Proxy NameText · Required
  8. Healthcare Proxy Phone NumberPhone · Required
  9. Healthcare Proxy RelationshipText · Required
  10. Additional Wishes or InstructionsLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Advance Directive Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Advance Directive Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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