About this template
The Virtual Care Appointment Form is designed to streamline the intake process for medical practices offering remote consultations. By moving your scheduling online, you reduce administrative overhead and ensure that your staff has all the necessary patient information before the consultation begins. This template allows patients to provide their contact details, select their preferred practitioner, and indicate the nature of their visit, all from the convenience of their own devices.
Using Doc2Form to deploy this template helps you maintain a professional and organized booking workflow. Instead of managing phone calls or manual emails, you can centralize all appointment requests in a single, easy-to-manage Google Sheet. This template is ideal for clinics, private practices, and wellness centers looking to modernize their patient experience and ensure that every virtual visit is scheduled accurately and efficiently.
Key features
- Collect essential patient contact information securely.
- Allow patients to select preferred practitioners and appointment types.
- Capture specific consultation needs to prepare for the visit.
- Standardize the intake process to save administrative time.
- Easily export appointment data to Google Sheets for tracking.
Use cases
- General practitioner e-visits and follow-ups.
- Mental health and tele-therapy intake sessions.
- Specialist consultations for remote patients.
- Wellness and nutritional counseling appointments.
What this form collects
- Full Name (Short answer)Please enter your full legal name.
- Phone Number (Short answer)Provide a direct number where we can reach you to confirm your appointment.
- Email Address (Short answer)We will send your appointment confirmation and video link to this address.
- Preferred Practitioner (Multiple choice)Select the doctor or specialist you would like to see.
- Appointment Type (Dropdown)What is the primary reason for your visit?
- Preferred Date (Date)Select your preferred date for the appointment.
- Preferred Time (Short answer)What time of day works best for your consultation?
- Consultation Method (Multiple choice)How would you prefer to conduct your virtual visit?
- Medical Records or Documents (Paragraph)Please paste a link to your file (Google Drive, Dropbox, etc.) or describe the document you wish to attach.
- Terms and Conditions (Checkboxes)By checking this box, you agree to our virtual care policies and consent to treatment via telecommunication.
FAQ
Can I customize the fields in this template?
Yes. Once you convert this template to a Google Form, you can add, remove, or edit any questions to better fit your clinic's specific intake requirements.
How do I manage the appointments once submitted?
Every submission is automatically saved to your linked Google Sheet, allowing you to track, sort, and manage your schedule in real-time.
Is this form suitable for all types of healthcare providers?
Yes, this template is versatile and can be used by doctors, therapists, nutritionists, and other healthcare professionals offering remote services.
Can I add a field for patients to upload documents?
While Google Forms does not support direct file uploads in a way that stores files in your drive, you can add a text field asking patients to paste a link to their documents from a secure cloud storage provider.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.