Patient Portal Registration Form

Streamline your healthcare practice's digital onboarding with this comprehensive Patient Portal Registration Form. Designed for medical practices, clinics, and healthcare providers looking to transition patients to secure online access, this template collects everything needed to create verified portal accounts while maintaining HIPAA-compliant workflows.

This patient registration form guides new users through identity verification, contact preferences, and optional caregiver proxy setup—all in one seamless experience. Whether you're a primary care practice, specialist clinic, or multi-location healthcare system, this template helps you digitize patient access while reducing administrative overhead.

Perfect for healthcare providers who need to:

• Onboard patients to secure online portals efficiently
• Verify patient identity before granting system access
• Collect communication preferences for appointments, results, and billing
• Enable authorized caregivers to access patient information
• Maintain organized digital records of portal registrations

Built with Paperform's conditional logic, you can show or hide caregiver proxy fields based on patient needs, route registrations to the right team members, and integrate seamlessly with your practice management software through Stepper workflows.

Once submitted, use Papersign (papersign.com) to collect required portal terms of service agreements and HIPAA acknowledgments with secure eSignatures, creating a complete audit trail for compliance. Connect this form to your existing healthcare systems via Stepper to automatically provision portal accounts, send welcome emails, and notify staff when proxy access requests need approval—all without manual data entry.

This template is ideal for family medicine practices, pediatric clinics, specialty practices, urgent care centers, and any healthcare provider implementing patient portal technology to improve access and engagement.