Consent Check-In Card
Pre-visit consent and health screening in a calm, one-question-per-screen flow.
A ready-to-use healthcare, legal & specialized form for teams with a niche process that generic forms don't cover: 9 questions, 1 page.
- Questions
- 9
- Pages
- 1
- Layouts
- card
Also filed under
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.
Compliance checklist
- Payment items priced — passingEvery payment question charges a real amount, so a submission always records a payment.
- Conditional logic resolves — passingEvery rule points at a question or page that exists in this template.
- Medical disclaimer present — passingThis form does not provide medical advice, diagnosis or treatment. Information you share here is not a substitute for care from a qualified clinician. In an emergency, contact your local emergency service immediately.
- Question labels unique — passingLogic and exports address questions by label, so duplicates are ambiguous.
What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.
Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.
Who this template is for
Consent Check-In Card is built for teams with a niche process that generic forms don't cover who need to capture reproducible detail on first contact.
- Teams with a niche process that generic forms don't cover working in healthcare, legal & specialized.
- Teams who need to capture reproducible detail on first contact without writing code or paying for a custom build.
- Anyone replacing requests that need three replies before work can start with one structured record per enquiry.
- Respondents are the specific group this workflow serves — the form asks them 9 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 requests that need three replies before work can start and turns each submission into a record your team can act on immediately.
- 6 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 captures a phone number for urgent follow-up.
- It records a signature you can keep as proof of agreement.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- 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 Consent Check-In Card 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.
- This template runs as a straight sequence: every respondent sees every question, in order.
- You can add branching yourself in the Logic tab — pick a question, a condition, and the field or page it should reveal, hide, require or skip to.
What this form asks
Every question is editable — rename it, make it optional, or delete it entirely.
Check in
- Patient / client namerequired
- Date of birthrequired
- Email addressrequired
- Phone number
- Reason for your visitrequired
- Do any of these apply?
- List any medication or allergies
- Agreementrequired
- Signaturerequired
9 questions in total.
Works in this layout
Forms that overlap this one
These pages cover the same subject ground as the consent check-in card, matched on the words people actually search for.
Quick Consent Check
agreementauthorizationcheckcomplianceconsent
Background Check Consent Form
authorizationcheckcomplianceconsentlegal
Dental New Patient Intake Form
agreementauthorizationcomplianceconsentintake
Background Check Authorization Form
authorizationcheckcomplianceconsentpre
Tattoo & Body Art Consent Form
agreementauthorizationcomplianceconsenthealth
Dental Clearance Form
agreementauthorizationcomplianceconsenthealth
Privacy & compliance
This form collects health information. Keep access limited to the people who need it, turn on encrypted answers for the clinical questions, and set a retention window so records don't sit in the dashboard forever.
Frequently asked questions
Is the Consent Check-In Card template free to use?
Yes. You can preview and test Consent Check-In Card 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 Consent Check-In Card template ask for?
It asks 9 questions across 1 page, 6 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 Consent Check-In Card form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the card layout, restyle it to match your brand, and set who gets notified on each submission.
Can I add conditional logic to this healthcare, legal & specialized form?
Yes. The template runs as a straight sequence out of the box, and you can add show, hide, require or skip rules in the Logic tab — pick a question, a condition, and the field or page it should affect.
Where do responses to the Consent Check-In Card 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 Consent Check-In Card 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.
Is the signature on this form legally usable?
The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.
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