Patient registration form
Add your clinic’s details and download a clean registration form to print for your front desk, or fill it in for one patient.
Leave any field empty to print a line and fill it by hand. Nothing you type leaves your browser, and only your clinic’s details are saved on this device.
What to ask a new patient
- Full name, and father’s or husband’s name.
- Date of birth or age, sex and CNIC.
- Phone number and address.
- An emergency contact.
- Allergies, long-term conditions and current medicines.
Keeping records safe
Registration forms hold private details, so keep them locked away and let only staff who need them see them. Paper forms are also hard to search, which is why many clinics move them into software once they grow.
For patients: what to bring
- Your CNIC, or a parent’s for a child.
- Old prescriptions and reports.
- A list of your medicines and allergies.
What to do next
Run your clinic on SehatDoc
Appointments, records, prescriptions and billing in one system, from PKR 4,000 a month.
See the featuresCommon questions
Still unsure? Send us the question and a person — not a bot — will answer it.
What is a patient registration form?
It is the first form a new patient fills in at a clinic. It records who they are, how to reach them, and their key medical background.
Should I collect the CNIC?
Many clinics do, because it tells apart patients with the same name. Ask only for what you need, and keep it private.
Can staff fill this in on a computer?
Yes, in the form on this page, then print it. For keeping records on an ongoing basis, patient management software is easier.
Try it with next week’s patients
Plans start at PKR 4,000 a month, billed in rupees, with setup and staff training included. Bring over next week’s patients and see whether the evening session runs any easier.
Setup help and staff training are included on every plan.