Clinical · free template

Trial Enrollment Screening

Screening form for clinical trial enrolment: eligibility questions, current treatment, availability for visits, consent to be contacted and next steps.

A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 24 questions, 3 pages, 4 conditional rules.

Questions
24
Pages
3
Layouts
classic · card
Time to complete
≈ 8 min
Conditional rules
4
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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 3 — Study and basic criteria

Which study, and basic eligibility

How did you hear about the study?
Do you have the condition or characteristic this study is recruiting for?

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

Compliance checklist

Ready to publish
  • 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

Trial Enrollment Screening 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 24 questions across 3 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.

  • 15 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 4 questions until they are relevant — shorter forms convert better than long ones.
  • Splitting the form across 3 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 Trial Enrollment Screening 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 — 4 conditional rules ship with it.

  • Features conditional validation: if “Are you currently taking part in another study?” is Yes, “Which study, and when does it end?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Can you travel to the study site?” is No, “What would make attending possible?” becomes mandatory before the form can be sent.
  • Features conditional validation: if “Do you take any regular medication?” is Yes, “Medication and doses” becomes mandatory before the form can be sent.
  • Features conditional validation: if “May we contact you about this study?” is Yes, “Best way to contact you” 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.

About this template

Screening is where recruitment either works or wastes everybody's time, and most of the waste comes from asking eligibility questions late. This three-page form asks them first. Page one identifies the study, records how the person heard about it, and covers the basic criteria that exclude the largest number of people: age range, location relative to the site, and the condition or characteristic the study requires. Page two covers current treatment and health: diagnoses, current medication, participation in any other study, previous involvement in research, and whether they are currently under the care of another service. Page three is practical availability, which is the reason many eligible volunteers withdraw later — the number of visits the study needs, whether they can travel to the site, whether they can take time from work, and who could accompany them. Consent to be contacted about this study is recorded explicitly, and the form states clearly that completing it is not enrolment and that informed consent for the trial itself is taken separately after a full discussion.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Study and basic criteria

  • Study name or referencerequired
  • Full namerequired
  • Date of birthrequired
  • How did you hear about the study?required
  • Town or area you live inrequired
  • Do you have the condition or characteristic this study is recruiting for?required
  • Anything about that you want to explain

Page 2 — Health and treatment

  • Diagnoses you have
  • Do you take any regular medication?required
  • Medication and doses
  • Are you currently taking part in another study?required
  • Which study, and when does it end?
  • Have you taken part in research before?required
  • Are you under the care of another service at the moment?required
  • Allergies and what happens on exposure

Page 3 — Availability and contact

  • Can you travel to the study site?required
  • What would make attending possible?
  • Could you attend several visits over the study period?required
  • Would you need time away from work or study?required
  • Who could come with you if needed?
  • Understandingrequired
  • May we contact you about this study?required
  • Best way to contact you
  • Questions you would like answered before deciding

24 questions in total.

Example of a completed trial enrolment screening form

A sample screening showing how a volunteer's basic eligibility and availability are captured before any consent discussion.

Study name or reference
Example Wellness Study, ref EX-204
Full name
Naomi Klein
Date of birth
15/09/1989
How did you hear about the study?
Poster or leaflet
Do you have the condition or characteristic this study is recruiting for?
Yes
Are you currently taking part in another study?
No
Can you travel to the study site?
Yes
Could you attend several visits over the study period?
Yes
May we contact you about this study?
Yes

Sample data — no real people, addresses or records are shown.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 4 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Are you currently taking part in another study?”

  • Makes answers required

    If “Are you currently taking part in another study?” is Yes, “Which study, and when does it end?” becomes required before the form can be submitted.

Driven by “Can you travel to the study site?”

  • Makes answers required

    If “Can you travel to the study site?” is No, “What would make attending possible?” becomes required before the form can be submitted.

Driven by “Do you take any regular medication?”

  • Makes answers required

    If “Do you take any regular medication?” is Yes, “Medication and doses” becomes required before the form can be submitted.

Driven by “May we contact you about this study?”

  • Makes answers required

    If “May we contact you about this study?” is Yes, “Best way to contact you” becomes required before the form can be submitted.

Set it up step by step

  1. 1

    Put the excluding criteria first

    Age, location and the recruiting characteristic filter the most people, so asking them on page one respects everybody's time.

  2. 2

    State plainly that this is not enrolment

    The understanding checkbox and a line in the intro prevent the misunderstanding that a completed screening form means a place in the study.

  3. 3

    Ask about visits honestly

    Volunteers who cannot make six visits will withdraw at visit two; better to know before consent than after randomisation.

  4. 4

    Keep the questions box

    What a potential participant wants to know shapes the consent discussion and often improves your participant information sheet.

Mistakes to avoid

  • Treating a screening form as consent, which it never is under any research framework.
  • Screening on clinical criteria only and discovering the travel problem after enrolment.
  • Contacting people who did not consent to be contacted about the study.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Screen submissions against the protocol criteria, contact only those who consented, and arrange the informed consent discussion separately before any study procedure takes place.

Works in both layouts

Browse classic templatesBrowse card templates

Forms that overlap this one

These pages cover the same subject ground as the trial enrollment screening, matched on the words people actually search for.

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

How is this different from the Research Study Screening Form?

That one is a general study screener. This is written for trial enrolment specifically, with the treatment, other-study and visit-availability questions a trial protocol usually requires.

Does completing this form enrol someone?

No. It is an enquiry and screening record. Informed consent for the trial is a separate documented conversation, and the form says so before the contact question.

Can it be used before ethical approval is in place?

No. Recruitment materials and screening forms normally require approval alongside the protocol, so confirm your approvals before publishing it.

How should screening data be retained?

Follow the retention terms in your approved protocol, including for people who were screened but never enrolled, and set that schedule before recruitment opens.

Is the Trial Enrollment Screening template free to use?

Yes. You can preview and test Trial Enrollment Screening 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 Trial Enrollment Screening template ask for?

It asks 24 questions across 3 pages, 15 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 Trial Enrollment Screening 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 “Are you currently taking part in another study?” is Yes, “Which study, and when does it end?” becomes mandatory before the form can be sent. Features conditional validation: if “Can you travel to the study site?” is No, “What would make attending possible?” becomes mandatory before the form can be sent. Features conditional validation: if “Do you take any regular medication?” is Yes, “Medication and doses” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Trial Enrollment Screening 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 Trial Enrollment Screening 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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