Superbill Template

About this template

A superbill template is a standardized document that healthcare providers use to record details of patient visits and services rendered for the purpose of billing insurance companies. With a free superbill template from Jotform, you can outline details like the patient’s name, date of service, diagnosis codes, procedure codes, and charges for individual services. When you’re finished customizing your template, you can send the attached form directly to your providers and other team members for them to fill out on any device. Each response will then instantly be converted to a PDF and forwarded to your Jotform Inbox for safekeeping.

Want to make the superbill template your own? Our drag-and-drop form builder makes that easy. Feel free to add or edit form fields, drop in your own logo, adjust colors and fonts to match your branding, and more. You can even integrate with our 100+ apps — like Google Drive and Dropbox — to store your information in one place. Streamline the medical billing process, reduce errors, and improve office efficiency with a free superbill template from Jotform.

Details
2,197 Clone
Created by
Related templates

Pregnancy Verification Template

Verify the pregnancies of your clinic’s patients easily. Drag and drop to customize your form. Send out copies. Works on desktop, tablet, and mobile devices.

Online Therapy Consent Template

Create an online therapy consent form to gather patient consent. Sign and fill out on any device. Drag and drop to fully customize. No coding knowledge required.

Doctors Note Template

Create a doctor’s note for your medical practice. Sign and send to your patients. Works on mobile, tablet, and desktop devices. Drag and drop to design.

Vaccination Record Card

Give this Vaccination Record Card to the individual who receives the vaccine and remind them to return for another dose if needed. This PDF template shows all the information needed by the individual about the vaccination process.

Prescription Template

Use this Prescription Template when prescribing medications or providing treatment regimens to the patients in order to address their health complaints. This PDF document can be opened on mobile devices by using a mobile browser and then opening the standard direct link.

Short Medical History

Medical History Record PDF template is mostly used in order to provide significant information about the health history, care requirements, and risk factors of the patient to doctors. It is for collecting data from the patients.

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.