Patient intake

Self-onboarding

Register once, answer the clinical pre-check questions, and join the live hospital queue. If you scanned a consultation room QR code, this form is already connected to that consult point.

Secure hospital registration

Patient information

This creates the master patient record used across every department.

Full name

Gender

Date of birth

Phone

Health ID from another platform

Health ID source

Address

Emergency contact

Emergency phone

Pre-check questions

These answers help triage and the selected department prepare.

Preferred department

Main reason for visit

How long has this been happening?

How severe is it?

Arrival mode

I currently have fever, chills, or feel unusually hot.