Forms and Surveys Use Cases

Forms and Surveys Use Cases

Forms and Surveys give providers a simple, digital way to collect information and feedback from patients, residents, families, and staff. Whether it’s replacing paper intake forms, gathering consent, or capturing valuable feedback after care, these tools help reduce administrative work, improve accuracy, and strengthen trust.

The use cases below highlight how Senior Care providers, Medical Clinics, and Hospitals can apply ACS Forms and Surveys across key areas such as operations, experience, compliance, reputation, preventative care, and financial stability.

Senior Care

  • Meal preference surveys
  • Post-discharge follow-up surveys
  • Post Discharge Call
  • Housekeeping and laundry satisfaction surveys
  • Transportation request forms
  • Activity participation sign-ups
  • Visitor policy acknowledgment forms

  • Incident reporting forms
  • Peer recognition nomination forms
  • Employee engagement surveys
  • Job satisfaction surveys
  • Post-training evaluation surveys
  • Professional development interest forms

  • HIPAA/privacy acknowledgment forms
  • Staff/Contractor HIPAA & Privacy Acknowledgment
  • Consent for release of medical records
  • Advanced directive or DNR confirmation forms
  • Quality assurance feedback forms
  • Incident reporting forms

  • Facility Environment Survey
  •  Activities & Engagement Survey
  • Core Q | Short Stay Discharge Survey
  • Core Q |  Long-Stay Residents and Family Members        
  • Core Q | Assisted Living Residents and Family Members 
  • Referral source satisfaction surveys
  • Community event feedback surveys
  • Suggestion box (digital submission forms)
  • Net Promoter Score (NPS) surveys

Medical Clinics

  • New patient registration
  • Insurance information
  • Demographic update 
  • Consent-to-treat and care preference
  • Medication adherence check-ins
  • Pre-Surgery Intake Form
  • Pre-op medical history form
  • Medication reconciliation form
  • Surgical consent form (
  • Risk factor survey 
  • Post-op pain management tracking
  • Surgical wound care instructions acknowledgment
  • Post-discharge follow-up care
  • Functional recovery surveys 
  • Complication monitoring forms 
  • Telehealth consent and readiness
  • Release of records requests
  • Referral request

  • Patient HIPAA/privacy acknowledgment
  • Staff/Contractor HIPAA & Privacy Acknowledgment
  • Adverse event/incident reporting
  • Vaccine consent and screening
  • Advance directive or DNR status verification form

  • Online review request
  • Referral partner satisfaction survey
  • Suggestion box (digital submission forms)

  • Patient satisfaction survey
  • Post visit follow-up visit survey
  • Appointment wait-time surveys
  • Comprehensive Wait-Time Survey (Quality Improvement Tool)
  • Telehealth experience surveys
  • Office environment/cleanliness feedback
  • Family/caregiver feedback survey on discharge readiness

Hosptials

  • Admission/pre-registration forms
  • Pre-op checklists
  • Discharge forms
  • Departmental handoff forms
  • Maintenance request forms

  • Surgical consent forms
  • Pre-op compliance checklists
  • CMS/HCAHPS reporting surveys
  • Adverse event reporting forms
  • Clinical audit forms

  • Volunteer Program Recruitment
  • Medical Student Education Program Launch
  • Award Recognition for Staff or Department
  • Charity Event Partnership Announcement
  • Community Survey for Hospital Feedback
  • Public Statement on Policy Change

  • Inpatient stay satisfaction surveys
  • Patient-reported outcomes surveys
  • HCAHPS/experience-of-care surveys
  • Post-discharge recovery surveys
  • Care transition surveys

  • Financial consent forms
  • Cost-estimate form
  • Post-discharge surveys (readmission risk
  • Payment authorization forms
  • Insurance coverage verification forms

What’s Next?