---
title: Alumni Health Professions Network Registration Form Template | Paperform
description: Create a professional healthcare alumni network with this registration form template. Capture licensure details, specialty areas, referral preferences, and HIPAA compliance acknowledgments.
url: "https://paperform.co/templates/alumni-health-professions-network-registration-form"
type: static
generatedAt: "2026-03-28T00:43:01.479Z"
---

[← Back to free form templates](/templates/)    ![Alumni Health Professions Network Registration Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/alumni-health-professions-network-registration-form.png)
    [Preview](https://_preview.paperform.co/ai-template/alumni-health-professions-network-registration-form) [Use this template for free](/create?ai-template=alumni-health-professions-network-registration-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Education Forms](/templates/category/education/) [Healthcare](/templates/industry/healthcare/)[Education](/templates/industry/education/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Dentist](/templates/role/dentist/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)[School Administrator](/templates/role/school-admin/)     About this free form template
### Connect with Healthcare Alumni and Grow Your Professional Network

Building a strong professional network is essential for healthcare practitioners—whether you're looking for peer referrals, collaboration opportunities, or simply want to stay connected with fellow graduates in the medical field. This **Alumni Health Professions Network Registration Form** makes it easy for educational institutions to create a comprehensive directory of healthcare alumni while capturing critical professional details like licensure, specialties, and referral preferences.

#### Why Use This Template?

Healthcare alumni networks serve multiple purposes: they help graduates connect for professional development, create referral networks that benefit patients, and strengthen ties between alumni and their alma mater. This form template is designed specifically for universities, medical schools, nursing programs, and allied health education programs that want to maintain an active, engaged community of healthcare professionals.

With Paperform, you can customize this template to match your institution's branding, add conditional logic to show relevant questions based on profession type, and collect structured data that makes building a searchable alumni directory effortless. The form includes fields for professional licensure verification, specialty areas, practice details, and patient referral acceptance—everything needed to create a valuable resource for your alumni community.

#### Key Features of This Template

 - **Professional credential capture** including license numbers, specialty areas, and practice information
 - **Patient referral preferences** to facilitate peer-to-peer referrals within the network
 - **HIPAA compliance acknowledgment** to ensure alumni understand privacy requirements
 - **Alumni discount opt-in** to promote special benefits for fellow graduates
 - **Contact and practice details** for easy directory creation

#### Automate Your Alumni Engagement with Stepper

Once alumni submit their registration, you can use [Stepper](https://stepper.io) to automatically add them to your alumni database, send welcome emails with directory access, trigger different workflows based on their specialty area, and keep your CRM or membership platform updated in real-time. Stepper's AI-native automation means you can create sophisticated alumni engagement workflows without any coding.

Whether you're building a new healthcare alumni network or refreshing an existing directory, this Paperform template gives you a professional, HIPAA-aware starting point that respects the unique needs of healthcare practitioners while making registration simple and efficient.
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![College Health Center to University Counseling Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/college-health-center-to-university-counseling-referral-form.png)

### College Health Center to University Counseling Referral Form

A comprehensive referral form for college health centers to refer students to university counseling services, including mental health screening results, academic impact assessment, and therapy recommendations.](/templates/college-health-center-to-university-counseling-referral-form/)
[![Medical Procedure Recording Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-procedure-recording-consent-form.png)

### Medical Procedure Recording Consent Form

A comprehensive consent form for recording medical procedures for educational and training purposes, with full IRB compliance and patient de-identification protocols.](/templates/medical-procedure-recording-consent-form/)
[![Medical Records Release for Medical School Admission](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-records-release-for-medical-school-admission.png)

### Medical Records Release for Medical School Admission

A comprehensive medical records release form for prospective medical students to authorize the transfer of health records, verify immunization compliance, document clinical fitness, and complete infectious disease screening requirements.](/templates/medical-records-release-for-medical-school-admission/)
[![Occupational Therapy Prior Authorization Form for School-Based Services](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/occupational-therapy-prior-authorization-form-for-school-based-services.png)

### Occupational Therapy Prior Authorization Form for School-Based Services

A comprehensive prior authorization form for occupational therapy services in educational settings, designed to clearly document whether services are educationally necessary, medically necessary, or both for insurance approval.](/templates/occupational-therapy-prior-authorization-form-for-school-based-services/)
[![Pediatric Food Allergy Action Plan & Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/pediatric-food-allergy-action-plan-consent-form.png)

### Pediatric Food Allergy Action Plan & Consent Form

Comprehensive food allergy management form for schools and childcare facilities, including emergency protocols, epinephrine auto-injector training consent, cafeteria accommodations, and HIPAA authorization for medical information sharing.](/templates/pediatric-food-allergy-action-plan-consent-form/)
[![Pediatric Immunization Catch-Up Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/pediatric-immunization-catch-up-consent-form.png)

### Pediatric Immunization Catch-Up Consent Form

A comprehensive consent form for pediatric catch-up immunizations with vaccine schedule review, parental concerns documentation, and school requirement tracking.](/templates/pediatric-immunization-catch-up-consent-form/)
[![Pediatric Sports Injury Treatment Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/pediatric-sports-injury-treatment-consent-form.png)

### Pediatric Sports Injury Treatment Consent Form

A comprehensive consent form for pediatric sports injury treatment, including HIPAA authorization, concussion assessment, physical therapy referral, playing status clearance, and parent communication preferences.](/templates/pediatric-sports-injury-treatment-consent-form/)
[![Physical Examination Consent Form for Minors](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/physical-examination-consent-form-for-minors.png)

### Physical Examination Consent Form for Minors

A comprehensive consent form for physical examinations of minors, including guardian presence options, sports participation clearance, and vaccination record review.](/templates/physical-examination-consent-form-for-minors/)
[![School-Based Health Services Poster Submission Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/school-based-health-services-poster-submission-form.png)

### School-Based Health Services Poster Submission Form

Submit your research poster on school-based health services, clinic operations, and student health outcomes for academic poster sessions and conferences.](/templates/school-based-health-services-poster-submission-form/)
[![Scoliosis Screening Form for School-Age Children](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/scoliosis-screening-form-for-school-age-children.png)

### Scoliosis Screening Form for School-Age Children

A comprehensive scoliosis screening form for school nurses and healthcare providers to document spinal examinations, Adam's forward bend test results, and orthopedic referral recommendations for early detection in children.](/templates/scoliosis-screening-form-for-school-age-children/)
[![University Alumni Gene Therapy Clinical Trial Registry](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/university-alumni-gene-therapy-clinical-trial-registry.png)

### University Alumni Gene Therapy Clinical Trial Registry

A comprehensive registry form for university alumni participating in gene therapy clinical trials, collecting genetic condition information, treatment history, research interests, and consent for biospecimen banking and long-term follow-up studies.](/templates/university-alumni-gene-therapy-clinical-trial-registry/)
[![Autism Spectrum Disorder Diagnostic Observation Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/autism-spectrum-disorder-diagnostic-observation-consent-form.png)

### Autism Spectrum Disorder Diagnostic Observation Consent Form

A comprehensive consent and information form for ASD diagnostic observation including ADOS-2 assessment, parent interview, school observation, and multidisciplinary team evaluation.](/templates/autism-spectrum-disorder-diagnostic-observation-consent-form/)