The new-patient form, on their phone
What's on the default form
- Full name, date of birth, gender, mobile, e-mail, address, emergency contact.
- Reason for the visit.
- Conditions checklist (diabetes, blood pressure, heart condition, asthma, bleeding disorder, pregnancy).
- Allergies, regular medicines, previous treatment.
- Consent to store the information for the patient's care.
Privacy
Ask only what you need for the visit. The link is unguessable and expires after the appointment, answers are never sent back to the browser once saved, and only staff of your clinic can open them. Nomisly does not currently sign HIPAA Business Associate Agreements, so US practices should keep protected health information in their own clinical system.
Frequently asked questions
Can patients use it without WhatsApp?
Yes. Staff can send or copy the link from the patient's page and share it by SMS, e-mail or in person.
Can I add my own questions?
Yes: text, long text, date, choice, checklist, phone, e-mail and consent questions, each optional or required.
Does it fill the patient record?
Name and date of birth are copied to the patient's profile when the form is completed; the rest stays in the encrypted form.
Written by the Nomisly Product Team. Last updated .