Healthcare & Clinical · community shared

Nurse Triage Form — shared by the community

Dev A. shared this 17-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: 17 questions, 2 pages, 3 conditional rules.

Shared by
Dev A. · Freelance consultant
Questions
17
Replies
6
Copies taken
47
See the library version

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Live preview and test console

This is the real form. Answer it to test the flow — nothing is sent or stored.

Page 1 of 2 — Contact and problem

Triage contact

How did the contact come in?

This template runs as a straight sequence — no branching rules.

Works for you? Take Dev A.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Nurse Triage 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 17 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.

  • 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
  • It pins the request to a specific date.
  • 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.

  1. 1Press “Use this template” — a fresh copy of Nurse Triage Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 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.
  4. 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.
  5. 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 “Disposition” is Escalated, “Escalated to whom, and when” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Any red flags identified?” is Yes, “Which red flags, and action taken” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Was safety-netting advice given?” is Yes, “What the patient was told to watch for” becomes mandatory before the form can be sent.
  • 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 — Contact and problem

  • Patient full namerequired
  • Date of birthrequired
  • Date of contactrequired
  • Time of contactrequired
  • How did the contact come in?required
  • Presenting problem in the patient's wordsrequired
  • Durationrequired
  • Relevant history and medication

Page 2 — Assessment and outcome

  • Observations recorded
  • Any red flags identified?required
  • Which red flags, and action taken
  • Advice givenrequired
  • Was safety-netting advice given?required
  • What the patient was told to watch for
  • Dispositionrequired
  • Escalated to whom, and when
  • Triaging clinicianrequired

Conditional logic in this build

  • When “Disposition” is Escalated, require “Escalated to whom, and when”.
  • When “Any red flags identified?” is Yes, require “Which red flags, and action taken”.
  • When “Was safety-netting advice given?” is Yes, require “What the patient was told to watch for”.

Questions about this shared form

Who fills this in?

The triaging clinician. When you want the patient's own account first, send the Quick Symptom Report and then complete this form against it.

Can it be used for telephone triage only?

It covers any route, which is why the contact-method question is there; the same record works for a call, an online request or a walk-in.

Does it decide urgency for us?

No. It documents the assessment and the decision a clinician made. No scoring or automatic prioritisation is applied to the answers.

How long should triage records be kept?

Treat them as clinical records and apply the retention rules for your setting, rather than the shorter schedule you might use for administrative forms.

Is the Nurse Triage Form template free to use?

Yes. You can preview and test Nurse Triage 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 Nurse Triage Form template ask for?

It asks 17 questions across 2 pages, 12 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 Nurse Triage 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 “Disposition” is Escalated, “Escalated to whom, and when” becomes mandatory before the form can be sent. Features conditional validation: if “Any red flags identified?” is Yes, “Which red flags, and action taken” becomes mandatory before the form can be sent. Features conditional validation: if “Was safety-netting advice given?” is Yes, “What the patient was told to watch for” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Nurse Triage 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 Nurse Triage 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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