Foot care assessment form for diabetic patients to monitor and prevent complications. It ships with 15 pre-configured fields, full drag-and-drop customization, dark-mode support, and one-click publish to a hosted link or website embed. Every field is editable — rename labels, change placeholders, adjust validation, swap field types, or add new fields as your workflow evolves.
All ZenBuild forms include automatic submission storage, CSV/Excel export, real-time analytics, and integrations with Google Sheets, Slack, Discord, Microsoft Teams, Zapier, Make, and custom webhooks. No coding required.
Fields included in this template
15 fields configured and ready to use:
01Patient Name (text, required)
02Patient ID (text, required)
03Date of Assessment (text, required)
04Years with Diabetes (number, required)
05Diabetes Type (dropdown selection, required) — options: Type 1, Type 2, Gestational, Pre-Diabetes
14Footwear Assessment (checkboxes, optional) — options: Proper Fit, Too Tight, Too Loose, Worn Out, Inappropriate Style
15Treatment Plan and Recommendations (long text, required)
Common use cases
•Use the Diabetic Foot Care Assessment template whenever you need to collect healthcare information.
•Collect patient information before appointments to reduce check-in time.
•Maintain HIPAA-aware workflows (enable HIPAA mode on Business plan for encrypted storage and audit logs).
•Trigger automated follow-ups based on submission responses.
How to use the Diabetic Foot Care Assessment template
Click Use this template to clone it into your ZenBuild account. Sign-up takes 10 seconds — email or Google works.
Open the form in the drag-and-drop builder. Rename the title, edit field labels, tweak validation rules, or add your brand logo and accent color.
Configure where responses go: store in ZenBuild, forward to a Google Sheet, post in Slack, or fan out via Zapier/Make.
Publish the form. You get a hosted link instantly. Optionally embed it on your website with a single line of HTML.
Share the link via email, social media, or QR code. Responses flow into your dashboard in real time.
Frequently asked questions
What is the Diabetic Foot Care Assessment template?
The Diabetic Foot Care Assessment template is a free, ready-to-use healthcare form built on ZenBuild. It contains 15 pre-configured fields that you can customize, brand, and deploy in minutes — no coding required.
How do I use this healthcare template?
Click "Use this template" to clone it into your ZenBuild dashboard. From there you can rename fields, change colors, add your logo, and adjust validation rules. Once you're happy, copy the share link or embed the form on your website to start collecting responses.
Is the Diabetic Foot Care Assessment template really free?
Yes. All ZenBuild templates are free to clone and use. The free plan lets you save up to 5 forms and collect 100 submissions per month. Paid plans unlock more forms, larger file uploads, payment collection, and advanced integrations.
Can I customize the fields in this template?
Absolutely. After cloning the template, every field is fully editable — labels, placeholders, validation, required state, and options. You can also add new fields, reorder them with drag-and-drop, or remove fields you don't need.
Where do responses to this form get stored?
All submissions are stored securely in your ZenBuild dashboard. You can view them in real-time, export to CSV or Excel, and forward them automatically to Google Sheets, Slack, Discord, Microsoft Teams, Zapier, Make, or any custom webhook endpoint.
