--- title: Value-Based Care Enrollment Form Template | Paperform description: Enroll patients in value-based care programs with this comprehensive form template for chronic condition management, care coordination, and quality measure tracking. url: "https://paperform.co/templates/value-based-care-enrollment-form" type: static generatedAt: "2026-04-03T00:50:28.426Z" --- [← Back to free form templates](/templates/) ![Value-Based Care Enrollment Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/value-based-care-enrollment-form.png) [Preview](https://_preview.paperform.co/ai-template/value-based-care-enrollment-form) [Use this template for free](/create?ai-template=value-based-care-enrollment-form) [Intake Forms](/templates/category/intake-forms/)[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 Value-Based Care Enrollment with Paperform Value-based care is transforming healthcare delivery by focusing on patient outcomes rather than service volume. This **Value-Based Care Enrollment Form** helps healthcare providers, medical practices, and accountable care organizations efficiently enroll patients in coordinated care programs while tracking quality measures and managing chronic conditions. #### Built for Modern Healthcare Workflows This template is designed for healthcare administrators, care coordinators, and medical practices transitioning to value-based payment models. Capture comprehensive patient information, assess chronic conditions, identify care needs, and establish shared savings participation agreements—all in one streamlined form. The form includes sections for patient demographics, insurance verification, chronic condition screening, care coordination preferences, quality measure baselines, and program consent. With conditional logic, you can tailor the enrollment experience based on specific conditions and care needs. #### Enhanced with Automation Tools Paperform integrates seamlessly with your existing healthcare systems. Connect submissions to your EHR, patient management software, or CRM to automatically create care plans and trigger follow-up workflows. Use **[Stepper](https://stepper.io)** to automate post-enrollment tasks like scheduling care coordinator consultations, sending welcome packets, assigning care teams, and setting up medication reconciliation appointments. For practices requiring signed participation agreements, **[Papersign](https://papersign.com)** enables you to convert form submissions into legally binding eSignature documents, ensuring compliant enrollment while maintaining a complete digital audit trail. #### Professional, HIPAA-Aware Design This template balances comprehensive data collection with user-friendly design. The multi-page format breaks complex enrollment into manageable sections, reducing patient overwhelm while ensuring complete information capture. Customize the theme, add your practice branding, and adjust questions to match your specific value-based care model. Whether you're launching an accountable care organization, implementing chronic care management programs, or participating in Medicare Shared Savings initiatives, this template provides the foundation for effective patient enrollment and care coordination. 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 [![Raynaud's Phenomenon Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/raynauds-phenomenon-screening-questionnaire.png) ### Raynaud's Phenomenon Screening Questionnaire A comprehensive screening tool for Raynaud's phenomenon that documents color changes, identifies triggers, assesses underlying conditions, and determines the need for rheumatology consultation.](/templates/raynauds-phenomenon-screening-questionnaire/) [![Thyroid Disorder Symptom Checklist](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/thyroid-disorder-symptom-checklist.png) ### 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