formisoft

Patient Portal Registration Form

Asks about email for portal access, mobile phone number, and preferred username. Built for new patient onboarding with portal enrollment.

Questions
10
Page
1
Time
about 3 min

Includes

  • Consent agreement
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Your practice

Patient Portal Registration Form

Live preview. Tap through it like a patient.

Who it is for

  • New patient onboarding with portal enrollment
  • Existing patient portal migration campaigns
  • Meaningful Use and MIPS compliance for patient engagement
  • Health system digital transformation initiatives

What's inside

  1. Patient Full NameText · Required
  2. Date of BirthDate
  3. Email for Portal AccessEmail
  4. Mobile Phone NumberPhone
  5. Preferred UsernameText
  6. Identity Verification (Last 4 SSN)Text
  7. Communication PreferencesCheckbox · 3 choices
  8. Appointment Reminder MethodDropdown · 3 choices
  9. Information acknowledgmentConsent Agreement
  10. Home AddressText

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 Patient Portal Registration 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

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 10 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 Patient Portal Registration Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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