Appointment Request Form

Make it easy for patients to request an appointment online from their phone or PC.

Reduce phone calls with an online appointment request form that can be embedded directly on your website. Patients can indicate the service they require and their availability, allowing you to send them an appointment time by SMS. They can also attach a copy of their referral letter with the form, reducing the number of steps it takes to make an appointment.

We store all responses on New Zealand-based servers under the guidelines of the New Zealand Privacy Principles, helping you protect patient confidentiality. Export responses directly into your practice management system for easy integration with your existing database.

You can use the template below, or design a new form from scratch for a fully-customisable, mobile-friendly option.