Insurance Form Template

Collect your patient’s current and complete insurance information, including images of the front and back of the insurance card. Avoid billing and payment delays with required fields and customizations.
insurance form template

Insurance Form Template

Give your patients the freedom to complete insurance forms with any device, anywhere. Streamline the way you collect vital information and intake forms by setting up your form online.

Easily personalize this insurance form template with a HIPAA compliant form builder.

Build a HIPAA compliant form for free

Start saving time and money with FormDr

What is an Insurance Form?

The insurance form can be completed by a patient as part of the intake process or any time insurance coverage changes. It requires all necessary information to contact, confirm coverage, and bill the insurer.

Today, approximately 90% of U.S. residents have health insurance with significant gains in health coverage occurring over the past 5 years. Health insurance facilitates access to care and is associated with lower death rates, better health outcomes, and improved productivity.

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Sync HIPAA Compliant Appointments with Google Calendar

Sync Appointments with Google Calendar

Authenticate your Google Calendar to receive appointment dates and times from your account.

HIPAA Compliant Submission Audit Logs

Submission Audit Logs

Form submissions have a detailed history that can always be referenced. Audit logs cannot be changed and the history from all users is tracked.

Card Photo Uploads

Card Photo Uploads

Have your patient take a picture of their insurance and ID cards. New patients will automatically upload a photo of their card information, so you can verify it before the appointment.

Custom Thank You Page

Custom Thank You Page

Create your own custom ‘Thank You’ page to direct patients to upon completion of your forms. Forward them along to the next steps of your intake process.

They love FormDr - and so do their patients

  • Not having an online custom form to offer patients was a huge struggle. FormDr makes paperwork seamless and saves a ton of time and money by allowing us to upload to patients EMR rather than print, fill out, scan, and then attach. That is now a hindrance of the PAST!

    Woodlands Dermatology
    Angela H.
  • Patients can fill out the forms at their leisure, and don’t have to print anything. We’re collecting more completed forms than ever, and patients love not having to do anything when they come to the office for the first time.

    FYZICAL MetroWest
    Lauren A.
  • FormDr allows me to send and receive attractive, professional forms from patients. Very helpful that I can remind patients of their appointment time and check the status of the form.

    Banks Hepatology Institute PC
    Alpha B.
  • Sending a PDF was too time consuming for the patients to do, and it required the additional steps of printing and scanning it into our own systems. FormDr made it easier to get patients to complete the forms by email, and it’s a more secure way to provide info than simply emailing back a completed PDF.

    Reload Therapy
    Angie I.
  • Before FormDr, the most common struggle were our patients taking a long time to complete forms in our office. Now patients are able to be seen faster when forms are completed prior to visit. Very easy service to create forms online!

    Skin Science Dermatology
    Courtney M.
  • The support is second to none. FormDr has been instrumental in streamlining our intake of new patients.

    Lang Orthodontics
    Eric L.
  • Before, clients weren’t signing our forms before the appointment. FormDr has allowed us to share our documents for client review and signatures. I really appreciate the support, it has been super helpful simplifying our forms!

    Meridian Behavioral Health
    Laura W.

Book a Free Consultation

Schedule a consultation with us to learn more

FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
  • Are emailing patients a PDF or Word Doc to print out, fill out, scan, and send back
  • Are spending time manually printing and scanning paper forms