formisoft

Clinical Trial Enrollment Form

Asks about full legal name, home address, and study name / protocol number. Built for academic medical center patient enrollment for sponsored trials.

Questions
15
Pages
2
Time
about 4 min

Includes

  • E-signature
  • Consent agreement
  • File upload
  • Medication list
  • Allergy list
  • Conditions checklist
  • Emergency contact
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Your practice

Clinical Trial Enrollment Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Academic medical center patient enrollment for sponsored trials
  • Contract research organization multi-site study intake
  • Community health center participation in public health studies
  • Pharmaceutical Phase I through Phase III trial screening

What's inside

Page 1 · Your information

  1. Full Legal NameText
  2. Date of BirthDate
  3. Phone NumberPhone
  4. Email AddressEmail
  5. Home AddressText

Page 2 · Additional details

  1. Known AllergiesAllergies
  2. Relevant Medical HistoryConditions
  3. Eligibility Screening QuestionsLong Text
  4. Supporting Medical RecordsFile Upload
  5. Emergency Contact NameEmergency Contact

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 Clinical Trial Enrollment 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.

Related templates

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 15 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. 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.

Yes. The Clinical Trial Enrollment Form works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Clinical Trial Enrollment Form to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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