Entry Forms
HearForm offers a number of styles or add your own entry forms. for example: Form number five on the screenshot below automatically mail merges a significant amount of patient demographic information right on to the patient entry form. When you hand a partially completed form to a patient, they are grateful that they do not have to fill out a form with information they may have already given you over the telephone. This also reduces errors, saves time and makes for much happier customers.
NOTE: HearForm will automatically fill in applicable information from the patient’s record to the entry forms. Be sure that you have previously entered the pertinent information on the “Patient Home” page before printing these forms.
There are 25 prepared entry forms from which to choose. Look at each form to see which ones might be appropriate for your needs. You can add more forms for a total of 50 Entry forms.
Samples:
- Sample of the Confidential Case History form
- Sample of an Entry form
- Sample of the Patient History - Full
- Sample of the Patient History - Empty
- Sample of the Confidential Case History - 1
- Sample of the Confidential Case History - 2
- Sample of the Registration Information - 1
- Sample of the Registration Information - 2
- Sample of the Patient Insurance Form - 1
- Sample of the Patient Insurance Form - 2
- Sample of the Treatment Consent
- Sample of the Cerumen Consent
- Sample of the Pre-Assessment
- Sample of the Facesheet
- Sample of the Referral for Medical Exam - 1
- Sample of the Referral for Medical Exam - 2
- Sample of the Pediatric Referral
- Sample of the Medical Clearance
- Sample of the Medical Waiver - 1
- Sample of the Medical Waiver - 2
- Sample of the Release of Records
- Sample of the Financial Policy
- Sample of the Acuerdo para Tratamiento
- Sample of the Nuestra Politica Comercial
- Sample of the Protesis Auditiva
- Sample of the Medidas de Privacidad