---
title: Patient Blood Management Program Enrollment Form Template | Paperform
description: Professional patient blood management enrollment form with anemia screening, bloodless surgery preferences, and transfusion alternatives. Perfect for hospitals and surgical centers implementing PBM programs.
url: "https://paperform.co/templates/patient-blood-management-program-enrollment-form"
type: static
generatedAt: "2026-03-28T00:44:44.143Z"
---

[← Back to free form templates](/templates/)    ![Patient Blood Management Program Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/patient-blood-management-program-enrollment-form.png)
    [Preview](https://_preview.paperform.co/ai-template/patient-blood-management-program-enrollment-form) [Use this template for free](/create?ai-template=patient-blood-management-program-enrollment-form)    [Registration Forms](/templates/category/registration/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline Patient Blood Management Program Enrollment with Paperform

Modern healthcare facilities are increasingly adopting **Patient Blood Management (PBM) programs** to optimize patient outcomes while minimizing the need for blood transfusions. Whether you're a hospital administrator, hematologist, or surgical coordinator, having a streamlined enrollment process is essential for identifying at-risk patients, documenting preferences, and ensuring safe, patient-centered care.

This **Patient Blood Management Program Enrollment Form** template is designed specifically for healthcare providers who need to efficiently capture patient information, screen for anemia risk factors, document bloodless surgery preferences, and assess eligibility for transfusion alternatives—all in one professional, HIPAA-aware workflow.

#### Built for Healthcare Workflows

With Paperform's flexible form builder, you can customize this template to match your facility's specific PBM protocols while maintaining a clean, professional patient experience. The form includes conditional logic that adapts questions based on patient responses, ensuring you only collect relevant information without overwhelming patients with unnecessary questions.

Key features include comprehensive patient intake sections, detailed anemia screening questions covering symptoms and risk factors, surgical history assessment, clear documentation of transfusion preferences and religious considerations, and evaluation of eligibility for blood conservation techniques and alternatives.

#### Automate Your PBM Workflow with Stepper

Once a patient submits their enrollment form, you can use **[Stepper](https://stepper.io)** to automatically route their information to the appropriate department—whether that's hematology for anemia management, surgery for bloodless technique planning, or patient services for consultation scheduling. Set up automated email notifications to care coordinators, create tasks in your practice management system, and maintain a complete audit trail of patient preferences and clinical assessments.

This template is ideal for hospital PBM coordinators, hematology departments, surgical services teams, anesthesiology practices, blood conservation specialists, and outpatient surgery centers implementing bloodless medicine programs.

#### Secure, Professional, and Patient-Friendly

Paperform's SOC 2 Type II compliance and robust security features make it an ideal platform for healthcare forms that handle sensitive patient information. The form can be embedded directly into your patient portal, shared via secure link, or accessed on any device, giving patients the flexibility to complete enrollment at their convenience while you maintain full control over data security and access.

Get started with this Patient Blood Management Program Enrollment template and transform how your facility manages blood conservation, patient preferences, and surgical planning—all without writing a single line of code.
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