Anemia Screening & Fatigue Assessment Form

Streamline Anemia Screening with Paperform

Anemia affects millions of people worldwide, yet early detection and assessment can be challenging without the right tools. This Anemia Screening & Fatigue Assessment Form template is designed for healthcare providers, primary care clinics, and wellness centers who need a systematic approach to identify patients at risk for anemia and determine appropriate next steps.

The form combines symptom assessment, dietary evaluation, and clinical decision support in one streamlined workflow. Healthcare professionals can quickly screen patients for anemia risk factors, assess fatigue severity using validated scales, evaluate dietary iron intake patterns, and determine whether lab tests or specialist referrals are needed—all within a single, mobile-friendly form.

How Paperform enhances your anemia screening workflow

Built with Paperform's conditional logic, this template adapts to each patient's responses. Severe cases automatically trigger hematology referral pathways, while moderate cases route to lab test ordering. The form calculates risk scores based on symptoms and dietary factors, helping clinicians prioritize cases and make informed decisions quickly.

With Paperform's healthcare-friendly features, you can embed this form directly on your patient portal, email it securely to patients for pre-visit completion, or use it chairside on tablets during appointments. Submissions sync seamlessly to your practice management system via Stepper, where you can automate follow-up emails, create tasks for care coordinators, and ensure no patient falls through the cracks.

The form is fully customizable to match your clinic's branding and specific protocols. Add your logo, adjust symptom severity thresholds, include lab-specific ordering codes, or integrate with your preferred lab partners. Whether you're a solo practitioner or part of a multi-location health system, this template scales to meet your needs while maintaining a professional, patient-friendly experience.

Start screening for anemia more effectively today with this ready-to-use template that combines clinical rigor with patient-centered design.