Medication Review Form — shared by the community
Dev A. 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
- Dev A. · Freelance consultant
- Questions
- 16
- Replies
- 22
- Copies taken
- 207
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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 — What you take
Every question on this page is currently visible.
Works for you? Take Dev A.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Medication Review 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.
- 8 questions are required, so submissions arrive complete instead of needing a follow-up email.
- 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 Medication Review 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 “Do you ever miss doses?” is Yes, sometimes, “What usually gets in the way?” becomes mandatory before the form can be sent.
- Features conditional validation: if “Have you noticed effects you think are from a medicine?” is Yes, “Which medicine, and what happens?” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Is cost an obstacle?” is Yes, the form dynamically exposes “Which items are hardest to afford?”. 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 — What you take
- Patient full namerequired
- Date of birthrequired
- Prescribed medicines, strength and how oftenrequired
- Anything bought without a prescription
- Vitamins, supplements or herbal products
- Anything stopped since the last review
- Usual pharmacy
Page 2 — How it is going
- Do you ever miss doses?required
- What usually gets in the way?
- Is the routine manageable?required
- Any practical problems?required
- Have you noticed effects you think are from a medicine?required
- Which medicine, and what happens?
- Is cost an obstacle?required
- Which items are hardest to afford?
- What would you most like to change?
Conditional logic in this build
- When “Do you ever miss doses?” is Yes, sometimes, require “What usually gets in the way?”.
- When “Have you noticed effects you think are from a medicine?” is Yes, require “Which medicine, and what happens?”.
- When “Is cost an obstacle?” is Yes, show “Which items are hardest to afford?”.
Questions about this shared form
Can pharmacists use this without the practice?
Yes. The questions are written from the patient's perspective, so a community pharmacy review works the same way, and the submission can be shared with the prescriber afterwards.
How does it relate to the Quick Refill Request?
The refill request is a routine ask for more of the same. This form is the periodic look at whether the regimen still fits, and it is much longer for that reason.
Should the form suggest changes?
No. It records what the patient reports and wants to discuss; every decision about a medicine sits with the prescriber reading the answers.
What about patients with long lists?
The free-text lines take as many entries as needed, and asking for one medicine per line keeps a fifteen-item list readable during the review.
Is the Medication Review Form template free to use?
Yes. You can preview and test Medication Review 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 Medication Review Form template ask for?
It asks 16 questions across 2 pages, 8 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 Medication Review 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 “Do you ever miss doses?” is Yes, sometimes, “What usually gets in the way?” becomes mandatory before the form can be sent. Features conditional validation: if “Have you noticed effects you think are from a medicine?” is Yes, “Which medicine, and what happens?” becomes mandatory before the form can be sent. Features advanced show logic: if “Is cost an obstacle?” is Yes, the form dynamically exposes “Which items are hardest to afford?”. Otherwise that question never appears. All rules are editable in the Logic tab.
Where do responses to the Medication Review 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 Medication Review 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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