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Telehealth Intake Form

Prepare patients for virtual visits. Professional telehealth intake form template for healthcare use cases.

Questions 8
Est. Time 2 minutes
Category Healthcare
Type Contact, Intake
HealthcareFitness
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Questions in this template
1
short text
Patient name
2
email
What's your email?
3
phone
What's your phone number?
4
multiple choice
Device for visit
5
long text
Current symptoms
6
long text
Questions for the doctor
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