On Line Enrollment form

  • The form can be modified for your practice / PHO 
  • The Link to it is added to your website or emailed to your new patients.  
  • You can ask your new patients to complete their enrollment form on line then import the patient’s details into MyPractice. 
  • The on line form can include their signature and documented proof of eligibility (e.g. copy of their passport or birth certificate). 
  • The form can be downloaded as a PDF then saved in the patients record satisfying a  audit requirements. 
  • The JotForms Online form service is free for up to 100 submitted forms per month

Create Your Form

  1. Go to the JotForms site and register yourself  as a new user https://www.jotform.com/
  2. Create a form using our template (type ‘mypractice’ into the search box then select The MyPractice Enrolment form
  3. Add a QR code to your website or your practice

QR Code for JotForm form

Customise the Form

Click on any section to select it then click on the edit button to the right 

Add your own practice name , address and phone number 

In the Enrollment section on page 2 update the form with your PHO name

Settings

In the Settings , remember to set your email address to receive the  submitted form 

Publish

Publish the form when completed

Copy the link to share and add this to your website or emails 

Receive Submitted forms as email

Go to your email 

Copy the patients details (highlight and press Ctl_C)

Get Details from the JotForms Site

Log into JotForms 

Select the enrolment form, Go To the Inbox (on the right)

Select the Patient’s submission 

Copy the patient details (highlight the text from ‘Name’ to the end of the form and Press CTL+C)

Import Patient Details

  1. Click New Patient
  2. Click On Import from Jotforms
  3. Paste into the text box and press [OK]
  4. Download the enrollment  PDF from Jotforms site and import into patients record