Clinical Trial Enrollment Form
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Clinical Trial Enrollment Form
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The Clinical Trial Enrollment Form provides a comprehensive intake workflow for patients interested in participating in clinical research studies. It captures all required demographic information, medical history relevant to study eligibility, current medications, and known allergies. By standardizing the enrollment process, your research coordinators can screen candidates efficiently and ensure no critical data points are missed during the initial intake.
This form includes dedicated sections for informed consent documentation, study-specific eligibility questions, and a detailed health questionnaire that covers prior diagnoses, surgical history, and ongoing treatments. Patients can upload supporting medical records and lab results directly through the form, reducing the need for follow-up requests. The built-in emergency contact and primary care physician fields ensure your research team can coordinate care seamlessly throughout the trial period.
Designed for academic medical centers, contract research organizations, pharmaceutical-sponsored trials, and community health centers participating in multi-site studies. Whether you are conducting Phase I safety trials or large-scale Phase III efficacy studies, this form gives your team a repeatable, compliant enrollment process that keeps study timelines on track and regulatory documentation organized.
What's included
- Complete patient demographics and contact information
- Study protocol identification and eligibility screening
- Medical history, medications, and allergy documentation
- Supporting medical record and lab result upload
- Emergency contact and primary care physician details
- Informed consent acknowledgment with signature capture
- Consent agreement with e-signature
- Structured medication list with dosage and frequency tracking
- Medical conditions checklist
Who uses this template
- 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
All form fields
15 fields across 3 pages. Customize any field after signing up.
How to use the Clinical Trial Enrollment Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Clinical Trial Enrollment Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Clinical Trial Enrollment Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 15 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Clinical Trial Enrollment Form HIPAA compliant?
Yes. All Formisoft templates, including the Clinical Trial Enrollment Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 15 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The Clinical Trial Enrollment Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Clinical Trial Enrollment Form for your practice. Set up in minutes.
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