Compliance · free template

Research Study Screening Form

Participant eligibility screener with consent language and scheduling for a follow-up call.

A ready-to-use healthcare, legal & specialized form for teams with a niche process that generic forms don't cover: 13 questions, 3 pages, 4 conditional rules.

Questions: 13
Pages: 3
Layouts: classic
Conditional rules: 4
Typical time: 6 min

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This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 3 — About you

Every question on this page is currently visible.

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

Research Study Screening Form 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 13 questions across 3 screens.

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.

8 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 pins the request to a specific date.
It captures a numeric value you can filter and sort on.
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.

1Press “Use this template” — a fresh copy of Research Study Screening 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 — 4 conditional rules ship with it.

Features skip logic: if “Are you within the study's target age range?” is No, respondents jump straight to “Consent & scheduling” and skip everything in between.
Features skip logic: if “Have you been diagnosed with the relevant condition in the past 12 months?” is No, respondents jump straight to “Consent & scheduling” and skip everything in between.
Features skip logic: if “Do you have any of the excluded conditions listed?” is Yes, respondents jump straight to “Consent & scheduling” and skip everything in between.
Features advanced show logic: if “Are you within the study's target age range?” is No, the form dynamically exposes “Thank you for your interest”. Otherwise that question never appears.
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 for a research study needs to filter out ineligible respondents quickly and politely, without making anyone feel judged for not qualifying. This form opens with basic demographics and contact details, then works through the study's core inclusion criteria one at a time — age range, relevant condition or experience, and any exclusion factors specific to the study. Each answer is scored behind the scenes against the eligibility rules the team defines, and as soon as a disqualifying answer is given, the form shows a brief, friendly exit message thanking the person for their time and explaining that they don't meet the current criteria, rather than continuing to ask questions that no longer matter. Respondents who pass every criterion move on to a short consent-to-be-contacted section and a scheduling question for an initial screening call, since most studies still require a live conversation before enrolment is confirmed. A field for how the respondent heard about the study feeds recruitment reporting without adding friction. Because eligibility rules vary enormously between studies, the specific inclusion questions here are a representative example — swap in the actual criteria for your protocol before publishing, and always route this data in line with your institution's ethics approval and data-handling requirements.

What this form asks

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

Page 1 — About you

Full namerequired
Email addressrequired
Phone number
Your agerequired

Page 2 — Eligibility criteria

Are you within the study's target age range?required
Have you been diagnosed with the relevant condition in the past 12 months?required
Do you have any of the excluded conditions listed?required

Page 3 — Consent & scheduling

Briefly describe your relevant medical or personal history
Are you willing to be contacted for a short screening call?required
Best date for a screening call
Preferred time of day
How did you hear about this study?
Agreementrequired

13 questions in total.

How the form changes as it's filled in

This template ships with 4 conditional rules, grouped into 4 behaviours driven by 3 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Are you within the study's target age range?”

Skips ahead
If “Are you within the study's target age range?” is No, the form skips “Consent & scheduling” entirely.
Reveals questions
If “Are you within the study's target age range?” is No, the form reveals “Thank you for your interest”.

Driven by “Have you been diagnosed with the relevant condition in the past 12 months?”

Skips ahead
If “Have you been diagnosed with the relevant condition in the past 12 months?” is No, the form skips “Consent & scheduling” entirely.

Driven by “Do you have any of the excluded conditions listed?”

Skips ahead
If “Do you have any of the excluded conditions listed?” is Yes, the form skips “Consent & scheduling” entirely.

Set it up step by step

1
Set your real inclusion/exclusion criteria first
Replace the example criteria in this template with your actual protocol's eligibility rules before sending it out.
2
Keep the exit message respectful
A short, warm decline message reduces complaints and keeps the door open for future studies with the same respondent.
3
Book screening calls promptly
Eligible respondents lose interest quickly — aim to schedule the screening call within a few business days.
4
Track source of referral
Use the 'how did you hear about this study' field to see which recruitment channel is producing eligible participants.

Mistakes to avoid

Leaving generic example criteria in place instead of the actual study protocol.
Making disqualified respondents answer every remaining question before showing the exit message.
Not clarifying that completing the form doesn't mean the person is enrolled yet.

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

Route eligible respondents to a screening call within a few days, log the referral source, and keep declined respondents' contact details on file only with their consent for future studies.

Works in this layout

Browse classic templates

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These pages cover the same subject ground as the research study screening form, 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

Does passing this screener enrol someone in the study?

No — it only identifies likely-eligible candidates. Formal enrolment happens after a screening call confirms eligibility in detail.

Can I customise the eligibility questions?

Yes, and you should — the questions here are a representative example. Replace them with your actual protocol's inclusion and exclusion criteria.

What should the disqualification message say?

Keep it brief, thank the person for their time, and avoid stating exactly which answer disqualified them.

Do I need ethics approval for this form?

Check with your institution — most research involving human participants needs the recruitment materials, including screening forms, reviewed by an ethics board first.

Is the Research Study Screening Form template free to use?

Yes. You can preview and test Research Study Screening 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 Research Study Screening Form template ask for?

It asks 13 questions across 3 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 Research Study Screening Form form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic layout, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this healthcare, legal & specialized form work?

4 conditional rules ship with the template: Features skip logic: if “Are you within the study's target age range?” is No, respondents jump straight to “Consent & scheduling” and skip everything in between. Features skip logic: if “Have you been diagnosed with the relevant condition in the past 12 months?” is No, respondents jump straight to “Consent & scheduling” and skip everything in between. Features skip logic: if “Do you have any of the excluded conditions listed?” is Yes, respondents jump straight to “Consent & scheduling” and skip everything in between. All rules are editable in the Logic tab.

Where do responses to the Research Study Screening 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 Research Study Screening 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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Related categories

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