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New patient request forms: a checklist for practice websites

The glass front entrance of a medical practice

For many people, the request form on your website is the first contact with your practice, often outside office hours. A good form is short, easy to use on a phone, clear about what happens next, and careful with the information it collects. This guide is for practice owners and the people who manage the practice website, whether that is someone on the team or an agency.

  1. SearchAn adult looks for care near them.
  2. Your pageWhat you treat, who sees them, one way to book.
  3. Call or formThey call or send a request.
  4. Front deskBooks the visit and never guesses a cause.
  5. Clinical teamThe clinician decides the plan.
How a new patient request reaches your practice.

1. Ask only for what you need to call back

A first request form needs very little: name, phone number, email, the treatment the person is interested in, and the best time to reach them. Medical history, insurance details and photos belong in the consultation process, not in a web form that goes to a shared inbox. Asking for less also means you hold less sensitive information.

2. Make it easy on a phone

  • Give every field a visible label, not only placeholder text. The W3C’s accessibility guidance (WCAG success criterion 3.3.2) asks for labels or instructions so people know what to enter.
  • Use the right input types and autocomplete values (for example a telephone field for the phone number), so phones show the right keyboard and can fill in details; see the web.dev guide to forms.
  • Use a short dropdown or buttons for the treatment, with an “other” option.
  • Show errors next to the field, in plain words, and keep what the person already typed.

Accessibility is not optional for a practice. The Justice Department’s guidance on web accessibility explains that businesses open to the public should make their websites accessible to people with disabilities as the ADA requires, and the W3C has a forms tutorial your developer can follow.

Next to the submit button, say how you will contact the person and why: for example, “By sending this form, you agree that [practice name] may call, text or email you about your request.” If you want to send marketing texts with an automated system, you need a separate prior express written consent with specific disclosures, and it cannot be a condition of booking. Our guide on texting patients and the TCPA covers the rules. Store the consent with the request: the date, the wording shown, and the number given.

4. Be careful with tracking on form pages

Analytics and advertising tags on form pages can send information about visitors to third parties. If your practice is a HIPAA covered entity, HHS has published guidance on online tracking technologies, and a federal court vacated part of it in June 2024, so review your setup with counsel. Practical steps that apply either way: never send form contents (names, phone numbers, treatment chosen) to analytics or ad platforms, check which tags load on the form and thank-you pages, and know what each tag collects.

5. Tell people what happens next

After the form is sent, show a thank-you page that says when and how you will reply (“We will call you within one business hour, from [number]”), with your phone number for anyone who prefers to call. Then keep that promise; see speed to lead for medical practices.

6. Route requests to a person, not just an inbox

  • Send each request to a named person or a shared queue that someone checks during opening hours.
  • Keep form contents out of email notifications where you can; a notice that a new request has arrived, with the details behind a login, is safer.
  • Test the form every month: send a request and time the reply.

7. Measure the form

Track how many people view the form page, how many send it, and how many of those book a consultation. Count form requests separately from calls, by source. See patient acquisition cost for turning those numbers into cost per new patient.

Where MediLeadGen fits

MediLeadGen requests arrive in a login-protected practice inbox, and the email alert carries no patient details. Each request goes to one practice only, with the person’s consent to be contacted by that practice, at a fixed price per delivered request.

See how it works for practices

Questions practices ask

What fields should a new patient request form have?

Name, phone number, email, the treatment of interest and the best time to call. Leave medical history, insurance and photos for the consultation process.

Do we need consent wording on our website form?

Yes, say clearly how you will contact the person. Marketing texts sent with an automated system need separate prior express written consent with specific disclosures; see our TCPA guide and check with counsel.

Can we use analytics and ad pixels on our form pages?

Be careful. Never send form contents to analytics or ad platforms. If you are a HIPAA covered entity, review HHS guidance on online tracking technologies with counsel.

Does our website form need to be accessible?

The Justice Department’s ADA guidance says businesses open to the public should make their websites accessible. Visible labels, clear errors and keyboard access are a good start.

General information for practice teams, not legal advice. Last reviewed October 2026.

More resources

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