Customize template

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Quickly and effortlessly optimize this medical records request sample, as our platform provides a variety of intuitive tools and multiple customization features. Play around with drag and drop to add, remove or rearrange fields, upload a logo, change the design theme and configure multiple email recipients for your form.

Publish template

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Patients will be able to request medical records even from their mobile devices since our web forms are mobile-friendly. Share with them this medical records request form by simply copying and pasting the form code in a web page. Clicking the social media buttons on our platform lets you instantly publish the form on a social media page.

Collect & manage data

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Managing sensitive healthcare information is no hassle with our secure medical records request form. Patient submissions are streamlined over a SSL connection and safely kept in an encrypted repository. With just a few clicks, you can make your medical forms HIPAA compliant as well. Manage all the data directly on our platform, export them on your preferred device or connect with third-party web apps.

Optimize your flow

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Improve your medical facility’s workflow with online medical forms that help both patients and doctors. Set up email notifications to receive alerts whenever a patient submits a medical records request. Automating your data collection with 123FormBuilder will significantly simplify your administrative work and save you time.

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  • nikon
  • univ-arkansas
  • aiesec
  • dc-fire
  • save-the-bay
  • how-to-web
  • think-edu