Addlify Forms — Patient Intake & Consent Forms for Clinics

🧪 testing preset / demo pacient

👤 Patient Information

First Name

Last Name

National ID / CNP

Gender

Phone Number

Email Address

🩺 Clinical Details

Reason for Visit / Symptoms

Known Allergies

Active Medications

📝 Consent & Digital Signature

I agree to the GDPR Medical Data Processing policy. My clinical data is stored only locally inside this device's memory. I authorize the attending physician to retrieve this clinical intake form and integrate it into my medical record.

Patient Digital Signature

🎉 Form Submitted Successfully!

Present this QR code to the clinic receptionist or scan it directly inside the Addlify Medic Word suite to check-in instantly.