New Medical/Dental Patient Form

Form Template

The New Medical Patient Form mobile app collects pertinent basic background information about a new patient for the creation of medical records.

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It can be downloaded to an iPhone, iPad, or Android device.

This simple registration process collects the patient's name, address, contact information, insurance information, and relevant contact information for organizations and family members affiliated with the individual are all recorded.

This patient registration form serves as a useful starting point for a database entry of the patient to which additional information such as patient history and notes can be appended later.

Each medical history is securely stored in the GoCanvas Cloud. You can email or print as a PDF document to a primary care physician, other health care providers, or to keep for your records.

  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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