Healthcare Forms & Patient Funnels
Transform your healthcare website into a powerful patient acquisition system with senior-friendly intake forms, care assessment funnels, and appointment scheduling.
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Patient Forms That Convert
Stop losing potential patients to complicated forms. Our senior-friendly intake forms and care assessment funnels guide families through seamless experiences, calculate care costs in real-time, and integrate with your patient management system—all with accessible, easy-to-read design.
Edit Your Forms Instantly
Need to update a form field, change a calculation, or add a new step? Just open your Site Bloom AI editor and make changes instantly with natural language commands.
"Add a discount field to the pricing calculator..."
"Update the contact form to include a phone number field..."
Done in seconds — no developer needed.
Scale Your Forms
Start with a simple contact form and evolve it into a sophisticated multi-step funnel as your business grows. Add new fields, integrations, or logic anytime — just ask your AI editor.
More Than Just Contact Forms
Build sophisticated patient intake forms and care assessment funnels that calculate care costs, qualify leads, book facility tours, and integrate with your patient management system.
Create forms with real-time calculations for care estimates, insurance coverage, out-of-pocket costs, and payment plans. Give families instant transparency.
Guide families through intelligent multi-step assessments with conditional logic to recommend the right level of care and services for their loved ones.
Integrate with your calendar system to let families book facility tours, consultations, and care assessments directly from your forms.
Automatically sync form submissions to your patient management system, CRM, or EHR. Keep your care coordination pipeline flowing smoothly.
Connect to any API or webhook. Send data to email systems, SMS notifications for families, or custom healthcare platforms.
Trigger automated workflows based on form responses. Send personalized care information, tour confirmations, and follow-ups to families instantly.
Perfect For Senior Healthcare Providers
From senior living communities to home healthcare agencies, our forms and funnels adapt to your specific care services.
Senior Living Communities
Create care cost calculators for assisted living, tour booking forms for families, or care level assessment funnels. Capture and qualify leads automatically while providing transparent pricing.
Home Healthcare Agencies
Build product recommendation quizzes, custom care plan forms, or caregiver matching assessments. Guide families to the perfect care solution with intelligent questions.
Medical Practices & Clinics
Design patient intake forms, appointment request systems, or new patient registration funnels. Collect detailed health information efficiently with senior-friendly interfaces.
Memory Care & Specialty Services
Create memory care assessment forms, respite care request systems, or specialized service inquiry funnels. Connect with concerned families at their most critical moment.
What You Get
- Senior-friendly design with accessibility standards
- Real-time care cost calculations and logic
- Integration with patient management systems
- Mobile-responsive and accessible design
- Spam protection and data validation
- Analytics and patient inquiry tracking
- Easy editing with no-code builder
Healthcare Forms & Funnels Pricing
Choose the perfect plan for your patient acquisition needs
Basic Patient Forms
Perfect for healthcare providers that need professional patient contact forms, tour requests, or simple care inquiry forms with basic integrations.
- Senior-friendly form design
- Up to 10 form fields
- Email notifications
- Auto-responder setup
- Spam protection
- Mobile responsive
- Basic validation
- 30 days support
Advanced Care Funnels
For healthcare providers that need sophisticated multi-step care assessments with cost calculations, conditional logic, patient management integrations, and advanced automation.
- Everything in Basic Patient Forms
- Multi-step care assessment design
- Real-time care cost calculations
- Conditional logic & branching
- Patient management system integration
- Tour and appointment booking integration
- Custom API connections
- Advanced patient inquiry tracking
- Automated family communication workflows
- 60 days priority support
Amplify Your Results
Combine powerful forms with targeted advertising and SEO to maximize your lead generation
Drive targeted traffic to your forms with precision Facebook advertising campaigns that convert.
Learn MoreCapture high-intent leads with Google Search and Display ads that reach customers actively searching.
Learn MoreRank higher in search results and attract organic traffic to your forms with strategic SEO optimization.
Learn MoreReady to Transform Your Patient Acquisition?
Let's build intelligent patient intake forms and care assessment funnels that convert families into residents. Schedule a demo to see what's possible for your senior healthcare organization.
Schedule Your Demo