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Appointment Request Form Template

Streamline Your Appointment Scheduling Process with Ease

Struggling to efficiently collect patient information for appointments? This appointment request form template is designed for healthcare providers looking to simplify the booking process. With this template, you can quickly gather essential details such as names, contact information, and appointment preferences, ensuring a fast and efficient scheduling process, enhancing patient satisfaction, and minimizing back-and-forth communication. Plus, it features WCAG-aligned labels for better accessibility. Start using the live template today to streamline your practice!

Use this Template (FREE) Live Preview
Full name
Email address
Mobile phone number
Preferred contact method
Phone call
Text message
Email
Any
Appointment type
In-person
Video/Virtual
Phone call
No preference
Appointment category
First-time appointment
Follow-up
Consultation
Other/Not sure
Reason for appointment
Preferred date
Preferred time window
Morning (8am-12pm)
Afternoon (12pm-5pm)
Evening (5pm-8pm)
Anytime
Preferred provider or location (if applicable)
How urgent is this request?
No urgency
Within 2-4 weeks
Within 1 week
Next available
Specific date only
Accessibility needs or accommodations (if any)
I consent to be contacted about this request
Yes
No
Signature
Date
I have reviewed the cancellation policy
Yes
No
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Email address, Mobile phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration featuring an appointment request form with blank fields and a pen for FormCreatorAI article

When to use this form

Use this template when you need to collect and triage booking requests for services, advising, or sales calls. It helps you capture purpose, timing, and contact details so you can confirm or reroute faster and cut back-and-forth. Clinics, salons, contractors, and campus teams can adapt it for new clients, follow-ups, and urgent issues. If you publish set time slots, pair it with the Appointment schedule form to show availability. For casual drop-ins, direct people to the Virtual office hours form. For simple one-off bookings, the Appointment form may be all you need. Academic teams can look at the CSE Advising appointment request form for a specialized flow you can copy.

Must Ask Appointment Request Questions

  1. What is the reason for your visit or meeting?

    Knowing the purpose lets you route the request to the right person and prepare any materials. Clear intent reduces back-and-forth and shortens time to confirmation.

  2. What dates and times work for you, and what is your time zone?

    Providing a few windows speeds scheduling and prevents avoidable reschedules. If you want to display weekdays for clarity, the Show day of the week form helps people pick the right option.

  3. How would you like to meet (in person, phone, or video)?

    This sets expectations for location, equipment, and any links you need to send. It also helps you assign the right room or virtual channel.

  4. What is your contact information (name, email, and phone)?

    Accurate contact details are essential for confirmations, reminders, and quick follow-ups. Asking for all three increases your chances of reaching the requester.

  5. Is there anything else we should know (goals, context, or accessibility needs)?

    Extra notes help you prepare and deliver a better experience in the first meeting. It also surfaces risks early, such as parking, mobility, or language support.

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