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Sample Form: درخواست نتیجه‌ی آزمایش

بیمار با کد پذیرش و کد ملی نتیجه را درخواست می‌کند؛ ارسال با پیامک یا ایمیل.

5 questions · Free up to 50 responses a month

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About this template

“درخواست نتیجه‌ی آزمایش” has 5 questions; 3 are required and 2 optional. Question types: Short text (1), National ID (1), Single choice (1), Mobile number (1), Email (1). 3 ready-made options across 1 choice questions, all editable in the online version.

In the online version of this template

  • National IDs are checked instantly with the check-digit algorithm.
  • Mobile numbers are validated against the Iranian number format.
Related:Online form builderIranian national ID validator

Questions in this template

  1. 1.

    کد پذیرش *

    (Short text)
  2. 2.

    کد ملی *

    (National ID)
  3. 3.

    روش دریافت *

    (Single choice)
    • پیامک
    • ایمیل
    • حضوری
  4. 4.

    موبایل

    (Mobile number)
  5. 5.

    ایمیل

    (Email)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
Download WordDownload PDF

Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “درخواست نتیجه‌ی آزمایش”.
  3. Change the questions as you like, publish the form and send the link.

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