Palliative Care Consultation Request & Research Form

Streamline Palliative Care Consultations with a Patient-Centered Research Form

Palliative care teams need to gather detailed, sensitive information quickly to provide the best possible comfort-focused care. This Palliative Care Consultation Request & Research Form template from Paperform helps healthcare providers, hospice organizations, and medical practices collect comprehensive patient information while maintaining dignity and compassion throughout the intake process.

Why This Template Works for Healthcare Teams

Built specifically for palliative care coordinators, case managers, and clinical research teams, this form template guides patients and families through identifying symptom management priorities, communication preferences, and readiness for advance care planning discussions. The thoughtful structure ensures no critical detail is missed while remaining sensitive to the emotional nature of these conversations.

The form captures essential information including current symptom severity, pain management preferences, care team communication styles, family involvement preferences, and readiness to discuss advance directives—all within a single, professional intake experience.

Automate Your Care Coordination Workflow

With Stepper, you can transform each submission into an automated care coordination workflow. Route urgent symptom reports to the appropriate clinical staff, schedule follow-up consultations based on readiness indicators, update patient management systems, and ensure care team members receive the right information at the right time—all without manual data entry.

For practices requiring signed consent forms or advance directive documentation, Papersign seamlessly converts form responses into legally binding eSignature documents, keeping all patient paperwork connected to their original consultation request for complete audit trails and compliance.

HIPAA Compliance Considerations

Important note: While Paperform offers SOC 2 Type II compliance and robust security features suitable for many healthcare workflows, it is not HIPAA compliant. Healthcare organizations handling protected health information (PHI) should ensure proper business associate agreements and security measures are in place, or use this template for research and pre-screening purposes only.

This template is trusted by palliative care programs, hospice organizations, healthcare researchers, and patient advocacy groups who need a compassionate, comprehensive way to begin the care planning conversation.