Remote Palliative Care Consultation Form

Compassionate Remote Palliative Care Made Simple

Providing quality palliative care requires deep understanding of your patients' physical, emotional, and spiritual needs—and now, more than ever, that care needs to reach patients wherever they are. This Remote Palliative Care Consultation Form is designed to help healthcare providers, hospice services, and palliative care teams gather the essential information needed to deliver compassionate, patient-centred care through telehealth.

Whether you're a palliative medicine specialist, hospice nurse, oncology practice, or home healthcare provider, this Paperform template streamlines the intake process for virtual consultations while maintaining the warmth and dignity your patients deserve.

Why Paperform for Palliative Care Telehealth?

Palliative care is about treating the whole person—not just symptoms. This form brings together symptom burden assessment, quality of life measurement, advance care planning documentation, and family coordination tools in one gentle, easy-to-navigate experience.

Built with SOC 2 Type II compliance and designed for GDPR adherence, Paperform keeps sensitive health information secure while giving your team the flexibility to collect exactly what you need. The form can be completed by patients, family members, or caregivers at their own pace, reducing stress and allowing for thoughtful reflection before your consultation call.

What This Template Includes

This comprehensive telehealth intake form covers:

• Patient and caregiver contact information for seamless communication
• Current care team details to ensure coordinated, collaborative care
• Detailed symptom burden assessment using validated scales for pain, breathlessness, fatigue, nausea, anxiety, and other common concerns
• Quality of life questionnaire measuring physical, emotional, social, and spiritual wellbeing
• Current medications and treatments to understand the full clinical picture
• Goals of care discussion to align your approach with patient values
• Advance directive and care planning document uploads for secure record-keeping
• Family meeting scheduling with flexible calendar integration for care conferences
• Questions and concerns capture so nothing important gets missed

Perfect for Multiple Palliative Care Settings

Whether you're working in:

• Hospice and palliative medicine practices conducting initial telehealth consultations
• Hospital-based palliative care teams doing remote follow-ups
• Oncology clinics providing supportive care alongside treatment
• Home health agencies coordinating comfort-focused care
• Senior care facilities arranging specialist consultations
• Geriatric care practices supporting aging patients with serious illness

This form adapts to your workflow while maintaining clinical rigor and human compassion.

Streamline Your Telehealth Workflow with Stepper

Once a patient completes this form, Stepper can help you automate what happens next. Create workflows that:

• Send submitted information directly to your EHR or patient management system
• Alert your clinical team via Slack or Microsoft Teams when urgent symptoms are reported
• Automatically schedule follow-up appointments based on symptom severity
• Create tasks in your project management tool for care coordination activities
• Send confirmation emails with telehealth visit links and preparation instructions
• Route advance directive documents to the appropriate secure storage location

Stepper's AI-native platform means you can describe your workflow in plain language and let automation handle the repetitive tasks, giving your team more time for what matters—caring for patients and families.

Secure eSignature Support with Papersign

Need signatures on consent forms, do-not-resuscitate orders, or advance directive acknowledgements? Papersign connects seamlessly with your Paperform submissions, turning responses into legally binding documents that can be signed electronically by patients, family members, and healthcare proxies. Everything stays connected to the original consultation form for complete documentation and audit trails.

Design That Respects the Patient Journey

This form uses a clean, uncluttered design with clear section headings and supportive language throughout. The tone is warm and professional, acknowledging the emotional weight of these conversations while making the process as straightforward as possible.

The multi-page layout breaks the form into manageable sections, preventing overwhelm while guiding patients and caregivers through each area of assessment. Conditional logic shows relevant follow-up questions only when needed, keeping the experience personalized and efficient.

Integration with Your Existing Tools

Paperform connects with the healthcare and productivity tools your practice already uses:

• Google Calendar or Outlook for family meeting scheduling
• Airtable, Google Sheets, or Monday.com for tracking consultation requests
• HubSpot or other CRMs for patient relationship management
• Slack or Teams for internal care team notifications
• Zapier, Make, or Stepper for custom automation workflows
• Webhooks for direct EHR integration where available

Built for Healthcare Providers Who Value Both Efficiency and Empathy

Over 500,000 teams trust Paperform to handle their most important workflows, and healthcare providers appreciate the balance of professional functionality and human-centred design. This template gives you enterprise-grade security and compliance without the enterprise-grade complexity—perfect for busy palliative care practices that need technology to support, not complicate, the care relationship.

Get started with this Remote Palliative Care Consultation Form template and bring compassionate, coordinated care to your patients wherever they are.