Patient Registration Form

Registration Forms

A patient registration form is satisfied when a patient arrives at the clinic or any hospital for medical treatment. Or simply, we can call it admission form. It is a form which gathers all the info about the patient. Those information fields consist of date and time of arrival, Patient name, age, gender, marital status, medical history if, any, previous consultant name, contact numbers, and home address, payment assurances, and insurance card number.

These data are for the administrative user, and they may turn a patient treatment record for the hereafter. If under any emergency, the patient needs immediate medical attention the form can be filled with the friends, parents, sibling, or by the guardian. If no one is available at the moment the patient can fill it after the treatment.

It is because of the assurance of payment or if he or she receives any kind of health policy. In an event the patient is alone and has no identity the hospital meets the form temporarily till the patient health is more adept and his mental status is sound for such matters to be talked about.

The format of the form is simple as discussed above, it consists of personal information, payment assurance, medical history, which facility to be used and consent for the medical procedures.

These forms are easily available at every clinic and hospitals. The figures are different for different medical institutions. They also act as a legal document in case of death of a patient or for the insurance determination. If some individual wants to have a form he can use thousands of available templates of the form available on a number of websites.


Preview and Details of Template

patient registration form template


FileWord (.doc) 2007+ and iPad 
Size 71 Kb   |  Download

File: OpenOffice (.odt) Writer [Writer]
Size 28 Kb   |  Download

License: ( General Use)
(distribution) by Kate Elizabeth(CEO)