Discharge Follow-Up Form — shared by the community
Marta K. shared this 16-question build with 3 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 16 questions, 2 pages, 3 conditional rules.
- Shared by
- Marta K. · Practice manager
- Questions
- 16
- Replies
- 21
- Copies taken
- 734
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Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
Page 1 of 2 — Since you came home
Every question on this page is currently visible.
Works for you? Take Marta K.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Discharge Follow-Up Form is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 16 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 11 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It captures a phone number for urgent follow-up.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Discharge Follow-Up Form lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 3 conditional rules ship with it.
- Features conditional validation: if “How are you feeling compared with discharge day?” is Worse, “What is worse?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Did you collect and start the medication you were sent home with?” is No, “What stopped you?” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Do you know when your follow-up appointment is?” is No, the form dynamically exposes “Would you like someone to call you?”. Otherwise that question never appears.
- All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — Since you came home
- Patient full namerequired
- Date of birthrequired
- Date you came homerequired
- How are you feeling compared with discharge day?required
- What is worse?
- Did you collect and start the medication you were sent home with?required
- What stopped you?
- Anything you are concerned about?required
- Tell us about it
Page 2 — At home
- Is someone at home with you?required
- What are you managing on your own?required
- Do you know who to contact if you are worried?required
- Do you know when your follow-up appointment is?required
- Would you like someone to call you?required
- Best number to call
- Anything else you want the team to know
Conditional logic in this build
- When “How are you feeling compared with discharge day?” is Worse, require “What is worse?”.
- When “Did you collect and start the medication you were sent home with?” is No, require “What stopped you?”.
- When “Do you know when your follow-up appointment is?” is No, show “Would you like someone to call you?”.
Questions about this shared form
Can a nurse complete it over the phone?
Yes, and that is often the point — the wording is written to be read aloud to a patient who is tired, and the answers still record consistently.
How does it relate to the Home Health Assessment?
This is the short check in the first week. The Home Health Assessment is the fuller three-page visit covering the home environment, mobility and care needs in detail.
Should it be used for urgent problems?
No. Say so in the intro and give the number to call instead; the form is reviewed during working hours and is not a substitute for urgent care.
Can we send it more than once?
Yes. A second submission at two weeks shows direction of travel, and comparing the same questions is more useful than adding new ones.
Is the Discharge Follow-Up Form template free to use?
Yes. You can preview and test Discharge Follow-Up Form on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Discharge Follow-Up Form template ask for?
It asks 16 questions across 2 pages, 11 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Discharge Follow-Up Form form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
3 conditional rules ship with the template: Features conditional validation: if “How are you feeling compared with discharge day?” is Worse, “What is worse?” becomes mandatory before the form can be sent. Features conditional validation: if “Did you collect and start the medication you were sent home with?” is No, “What stopped you?” becomes mandatory before the form can be sent. Features advanced show logic: if “Do you know when your follow-up appointment is?” is No, the form dynamically exposes “Would you like someone to call you?”. Otherwise that question never appears. All rules are editable in the Logic tab.
Where do responses to the Discharge Follow-Up Form form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Discharge Follow-Up Form form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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