Free Form Templates


Healthcare experts all around the world use 123ContactForm to collect and compile patient records online through secure medical forms that are ruled under the principles of the Health Insurance Portability and Accountability Act.

If you are interested in using 123ContactForm as your trusted HIPAA compliant solution for building medical forms, press the button below to schedule a call with us. We are eager to hear your story and help you get started.

Browse the menu on the left to view some of the medical forms that you may create with the 123ContactForm HIPAA compliant form builder.

Key components of the 123ContactForm form builder:

  • Business Associate Agreement
  • Scalable Results within an Independent System
  • Dedicated Technical Consultation
  • Fully customizable solution

Patient Registration Form

Use this patient registration form that your patients may fill out to arrange appointments with your office.

Medical History

Use this medical history form to collect symptoms from your patients online and return with a diagnosis.

Health Survey

Use this health survey to learn more about the health and habits of your patients.