--- title: Medical Records Request Form for Concierge Medicine Enrollment | Paperform description: Professional medical records request template for concierge medicine practices. Collect patient health history, preventive care screenings, and wellness program data for seamless enrollment. url: "https://paperform.co/templates/medical-records-request-for-concierge-medicine-enrollment" type: static generatedAt: "2026-04-04T00:44:34.238Z" --- [← Back to free form templates](/templates/) ![Medical Records Request for Concierge Medicine Enrollment](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medical-records-request-for-concierge-medicine-enrollment.png) [Preview](https://_preview.paperform.co/ai-template/medical-records-request-for-concierge-medicine-enrollment) [Use this template for free](/create?ai-template=medical-records-request-for-concierge-medicine-enrollment) [Intake Forms](/templates/category/intake-forms/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/) About this free form template ### Streamline Your Concierge Medicine Enrollment with Medical Records Requests Transitioning to concierge medicine represents a commitment to proactive, personalized healthcare. This **Medical Records Request for Concierge Medicine Enrollment** template from Paperform makes it simple for healthcare providers to gather comprehensive patient histories, preventive care records, and wellness program participation details—all in one secure, professional form. #### Why Paperform for Medical Records Requests? Concierge medicine practices, boutique healthcare providers, and wellness-focused clinics need to collect detailed health information efficiently while maintaining patient trust and regulatory compliance. This template helps you: - **Centralize patient information**: Capture previous provider details, health history, screenings, and wellness activities in a single submission - **Present a premium experience**: Create on-brand forms that reflect the elevated service standards of concierge medicine - **Automate follow-up workflows**: Use [Stepper](https://stepper.io) to automatically send records requests to previous providers, update your practice management system, and trigger onboarding sequences - **Maintain compliance**: Paperform is SOC 2 Type II compliant with robust security controls, helping you protect sensitive health information #### Perfect for Healthcare Providers Who Value Efficiency Whether you're a concierge medicine practice, executive health program, direct primary care clinic, or wellness-focused medical group, this template adapts to your intake process. The form collects authorization for records release, details about previous providers, comprehensive health history including chronic conditions and medications, preventive care screening dates, and wellness program participation. By digitizing this critical step in patient onboarding, you eliminate paper forms, reduce administrative burden, and create a smoother enrollment experience that matches the premium care you provide. Connect submissions to your EHR system, CRM, or practice management platform through Paperform's native integrations or Stepper workflows—no coding required. #### Get Started in Minutes Simply customize this template with your practice branding, add any specialty-specific questions, and embed it on your website or share via email. Every submission is securely stored and can trigger automated follow-up actions, ensuring no patient falls through the cracks during enrollment. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Raynaud's Phenomenon Screening Questionnaire](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/raynauds-phenomenon-screening-questionnaire.png) ### Raynaud's Phenomenon Screening Questionnaire A comprehensive screening tool for Raynaud's phenomenon that documents color changes, identifies triggers, assesses underlying conditions, and determines the need for rheumatology consultation.](/templates/raynauds-phenomenon-screening-questionnaire/) [![Thyroid Disorder Symptom Checklist](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/thyroid-disorder-symptom-checklist.png) ### 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