Quick Records Request — shared by the community
Priya N. shared this 12-question build with 4 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: 12 questions, 1 page, 4 conditional rules.
- Shared by
- Priya N. · Operations lead
- Questions
- 12
- Replies
- 19
- Copies taken
- 436
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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.
This template runs as a straight sequence — no branching rules.
Works for you? Take Priya N.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Quick Records Request 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 12 questions across 1 screen.
- 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.
- 9 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It accepts a document or photo upload as evidence.
- It pins the request to a specific date.
- It captures a full postal address.
- Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
- 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 Quick Records Request 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.
- 4Check the upload limits on the file question so respondents can attach what you actually need.
- 5Publish 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.
- 6Watch 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 — 4 conditional rules ship with it.
- Features conditional validation: if “Who is making this request?” is Someone acting for the patient, “Basis for acting on the patient's behalf” becomes mandatory before the form can be sent.
- Features conditional validation: if “How should the copies be sent?” is Secure electronic copy, “Email address” becomes mandatory before the form can be sent.
- Features conditional validation: if “How should the copies be sent?” is Post, “Postal address for the copies” becomes mandatory before the form can be sent.
- Features conditional validation: if “Which records are needed?” is Something specific, “Describe exactly what is needed” becomes mandatory before the form can be sent.
- All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Records request
- Patient full namerequired
- Patient date of birthrequired
- Who is making this request?required
- Basis for acting on the patient's behalf
- Which records are needed?required
- Describe exactly what is needed
- From daterequired
- To daterequired
- How should the copies be sent?required
- Email addressrequired
- Postal address for the copies
- Photo of an identity documentrequired
Conditional logic in this build
- When “Who is making this request?” is Someone acting for the patient, require “Basis for acting on the patient's behalf”.
- When “How should the copies be sent?” is Secure electronic copy, require “Email address”.
- When “How should the copies be sent?” is Post, require “Postal address for the copies”.
- When “Which records are needed?” is Something specific, require “Describe exactly what is needed”.
Questions about this shared form
How is this different from the Records Release Form?
The Records Release Form is the fuller authorisation for sending records to a third party such as an insurer or another clinic. This one is the patient asking for their own copies.
Do we have to charge for copies?
That depends on the rules where you practise and on the request itself, so state your position in the intro rather than leaving patients to guess.
What if someone asks on behalf of a relative?
The form captures the basis they are relying on, and your team still has to satisfy itself that the authority is genuine before anything is released.
Can we require a specific identity document?
Yes. Name the documents you accept in the field's help text; the upload is only useful if it shows what your process actually needs.
Is the Quick Records Request template free to use?
Yes. You can preview and test Quick Records Request 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 Quick Records Request template ask for?
It asks 12 questions across 1 page, 9 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 Quick Records Request 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?
4 conditional rules ship with the template: Features conditional validation: if “Who is making this request?” is Someone acting for the patient, “Basis for acting on the patient's behalf” becomes mandatory before the form can be sent. Features conditional validation: if “How should the copies be sent?” is Secure electronic copy, “Email address” becomes mandatory before the form can be sent. Features conditional validation: if “How should the copies be sent?” is Post, “Postal address for the copies” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Quick Records Request 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 Quick Records Request 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.
Can respondents upload files?
Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.
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