---
title: Remote Palliative Care Consultation Form Template | Paperform
description: Comprehensive telehealth palliative care intake form with symptom assessment, quality of life questionnaire, advance directive upload, and family meeting scheduling for virtual healthcare visits.
url: "https://paperform.co/templates/remote-palliative-care-consultation-form"
type: static
generatedAt: "2026-03-28T00:45:01.655Z"
---

[← Back to free form templates](/templates/)    ![Remote Palliative Care Consultation Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/remote-palliative-care-consultation-form.png)
    [Preview](https://_preview.paperform.co/ai-template/remote-palliative-care-consultation-form) [Use this template for free](/create?ai-template=remote-palliative-care-consultation-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/)[Senior Care](/templates/industry/senior-care/)[Hospice & Palliative Care](/templates/industry/hospice/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Caregiver](/templates/role/caregiver/)     About this free form template
### 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](https://stepper.io) 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](https://papersign.com) 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.**
       Built for growing businesses, trusted by bigger ones.   Trusted by 500K+ business owners and creators, and hundreds of millions of respondents.     ![Capterra - 4.8 out of 5](/images/capterra-st.jpg)
 ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg)
 ![G2 - 4.8 out of 5](/images/g2-st.jpg)
  [Try Paperform free now](/register)
## More templates like this
  [![Healthcare Care Transition Coach Patient Survey](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/healthcare-care-transition-coach-patient-survey.png)

### Healthcare Care Transition Coach Patient Survey

A comprehensive post-discharge survey to assess hospital-to-home transition support, medication management, follow-up care coordination, and patient understanding of warning signs requiring immediate medical attention.](/templates/healthcare-care-transition-coach-patient-survey/)
[![Hospice Care Admission and Consent Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-admission-and-consent-form.png)

### Hospice Care Admission and Consent Form

A comprehensive hospice care admission form to collect patient information, treatment consent, DNR preferences, pain management options, HIPAA authorization, and end-of-life care decisions with family notification settings.](/templates/hospice-care-admission-and-consent-form/)
[![Hospice Care Discovery Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-discovery-form.png)

### Hospice Care Discovery Form

A compassionate intake form for hospice care providers to assess patient needs, medical status, symptom management requirements, spiritual preferences, and family support services.](/templates/hospice-care-discovery-form/)
[![Hospice Patient Emergency Contact Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-patient-emergency-contact-form.png)

### Hospice Patient Emergency Contact Form

A comprehensive hospice emergency contact form that captures patient comfort care preferences, spiritual support details, funeral arrangements, and family notification hierarchy for end-of-life care coordination.](/templates/hospice-patient-emergency-contact-form/)
[![Palliative Care New Patient Intake Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/palliative-care-new-patient-intake-form.png)

### Palliative Care New Patient Intake Form

A comprehensive intake form for new palliative care patients to document medical history, symptom management needs, advance care planning, spiritual preferences, and caregiver information.](/templates/palliative-care-new-patient-intake-form/)
[![Remote Geriatric Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/remote-geriatric-assessment-form.png)

### Remote Geriatric Assessment Form

Comprehensive telehealth assessment form for elderly patients including cognitive screening, fall risk evaluation, medication review, and care planning.](/templates/remote-geriatric-assessment-form/)
[![Residential Hospice Application Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/residential-hospice-application-form.png)

### Residential Hospice Application Form

A compassionate application form for residential hospice care admission, collecting medical documentation, care preferences, and family visitation details to ensure dignified end-of-life support.](/templates/residential-hospice-application-form/)
[![Community Paramedicine Home Monitoring Referral Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/community-paramedicine-home-monitoring-referral-form.png)

### Community Paramedicine Home Monitoring Referral Form

A comprehensive referral form for community paramedicine programs to connect patients with chronic disease home monitoring, medication management, telehealth setup, and mobile integrated healthcare services.](/templates/community-paramedicine-home-monitoring-referral-form/)
[![Geriatric Care Assessment Appointment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/geriatric-care-assessment-appointment-form.png)

### Geriatric Care Assessment Appointment Form

Schedule a comprehensive geriatric care assessment appointment with cognitive screening, fall risk evaluation, medication review, and caregiver support assessment.](/templates/geriatric-care-assessment-appointment-form/)
[![Geriatric Medicine Comprehensive Assessment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/geriatric-medicine-comprehensive-assessment-form.png)

### Geriatric Medicine Comprehensive Assessment Form

A thorough new patient intake form for geriatric medicine practices covering medical history, fall risk screening, cognitive assessment, medication reconciliation, functional status, and advance care planning.](/templates/geriatric-medicine-comprehensive-assessment-form/)
[![Hospice Bereavement Services Family Contact & Data Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-bereavement-services-family-contact-data-request-form.png)

### Hospice Bereavement Services Family Contact & Data Request Form

Request family contact information and data access for hospice bereavement services, including grief counseling sessions, memorial events, and support resources.](/templates/hospice-bereavement-services-family-contact-data-request-form/)
[![Hospice Care Consultation Age Verification](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/hospice-care-consultation-age-verification.png)

### Hospice Care Consultation Age Verification

Verify eligibility and gather essential information for hospice care consultations, including age confirmation, diagnosis details, insurance review, and care preferences.](/templates/hospice-care-consultation-age-verification/)