SurveyMonkey is built to handle every use case and need. Explore our product to learn how SurveyMonkey can work for you.

Get data-driven insights from a global leader in online surveys.

Integrate with 100+ apps and plug-ins to get more done.

Build and customize online forms to collect info and payments.

Create better surveys and spot insights quickly with built-in AI.

Purpose-built solutions for all of your market research needs.


Measure customer satisfaction and loyalty for your business.

Learn what makes customers happy and turn them into advocates.

Get actionable insights to improve the user experience.

Collect contact information from prospects, invitees, and more.

Easily collect and track RSVPs for your next event.

Find out what attendees want so that you can improve your next event.

Uncover insights to boost engagement and drive better results.

Get feedback from your attendees so you can run better meetings.

Use peer feedback to help improve employee performance.

Create better courses and improve teaching methods.

Learn how students rate the course material and its presentation.

Find out what your customers think about your new product ideas.


Best practices for using surveys and survey data

Our blog about surveys, tips for business, and more.

Tutorials and how to guides for using SurveyMonkey.

How top brands drive growth with SurveyMonkey.

Contact SalesLog in
Contact SalesLog in

Patient Registration Form Template

Efficiently manage patient information.

SurveyMonkey is rated 4.5 out of 5 from 18,000+ reviews on

A patient registration form makes it easy to collect comprehensive and accurate patient information essential to delivering high-quality care, ensuring patient safety and complying with legal and insurance requirements.

Improve your patient onboarding process with our Patient Registration Form Template. Our Patient Registration Form Template is designed to meet the needs of various medical settings, including clinics, doctor’s offices, and hospitals.

This form makes it easy to collect essential patient information, ensuring a smooth and efficient registration process for your healthcare practice. Whether you’re intaking a new patient or signing in a patient for standard treatment, our Patient Registration Form Template has you covered.

Our expertly designed form template includes essential fields like:

  • Patient's name and contact information
  • Date of birth and gender
  • Medical history and current medications
  • Insurance information
  • Emergency contact details
  • Consent and privacy acknowledgments

Use our intuitive drag-and-drop form builder to easily modify fields to meet your specific requirements, and update the form design to reflect your practice’s branding. Then, share your customized online form with patients via email, website, or embedded on your website to create an efficient patient registration process. 

Streamline patient intake and improve healthcare efficiency with our Patient Registration Form Template—begin optimizing your registration process today.

We have so many powerful features to help you launch surveys quickly, but here are our most popular ones for new users.

Out-of-the-box themes, accessible color palettes, custom fonts, branding, and more.

Collect survey responses via email, website, SMS, social media, QR codes, offline, and more.

Automatic results summaries, filters, custom dashboards, crosstab reports, text analysis, & more.

Read about our customers, explore webinars, and get guides on collecting feedback in your industry.

Get tips on how to create better surveys, hear the latest product news, or check out our research.

Access tutorials on how features work, learn more about billing, and contact Customer Support.

Measuring quality of care to improve the patient experience

Healthcare leaders can use this toolkit to help better understand the patient and employee experience.

Learn how Carrot boosts clinical outcomes with feedback

Discover how Carrot relies on SurveyMonkey for HIPAA-compliant surveys, improved data collection, and better clinical outcomes.

How to use Forms to enhance your survey experience

How do surveys and forms differ? Learn how to combine form data with survey feedback for seamless events and experiences.

How to improve your patient registration process

Efficient patient registration makes onboarding easy and saves time. But what do you need to collect, and how? We can help.