Have you ever looked for an “Against Medical Advice form” only to find yourself stuck with non-editable PDF documents?
We’ve been there!
Most forms fail to meet specific requirements because they are outdated, hard to use, and don’t fit specific needs—like pediatric care, in-home treatment, or quick signature-only cases.
That’s why we’ve created 11 editable AMA form templates using Google Docs to address these challenges.
These templates allow customization through logo addition and wording adjustments while providing the option to include extra sections.
Also see: Free Veterinary Against Medical Advice Forms
Through analysis of actual AMA forms we selected necessary fields and structured them in straightforward tables for better organization.
And yes, they’re completely free!
Let’s take a look at what we’ve made.
Usage Note: These templates are free to use for both personal and commercial purposes. However, redistribution, resale, or uploading these templates to other websites or platforms for download or sale is strictly prohibited. Please respect the effort that went into creating these resources by using them responsibly.
How to Use These AMA Intake Form Templates
These AMA form templates require a Google Account because they have been created using Google Docs.
After signing in you must click the “Get this template” button located under your chosen template. The preview page opens when you click the link and you can create your own copy by pressing “USE TEMPLATE”.
After accessing the template you can edit the form according to your needs before printing it out for clients to complete. It’s that simple.
1. The Standard Hospital AMA Form
This standard AMA form is ideal for general hospital discharges in most cases.
The AMA form begins by collecting basic information which includes Patient Name followed by DOB and Medical Record Number. The form continues with departure details followed by the physician’s name.
The condition, recommended treatment and potential risks are displayed in a basic two-column table format.
A final statement confirms patient awareness of risks while choosing to leave, followed by spaces for necessary signatures.
2. The Standard Hospital AMA Form (Color)
This version of the standard AMA form features modernity through a clean borderless design with soft blue-green headers that make it visually appealing.
The design stays true to the original AMA format while offering a modernized appearance.
3. Minimalist AMA Form
Need something quick and no-frills?
The form includes essential elements such as name input, date entry alongside key legal points together with spaces for signatures.
Ideal for busy clinics or urgent care
4. Pediatric AMA Form
Since most AMA forms exclude children and those under guardianship from their intended use we developed one that is suitable for these cases.
This version is for parents or guardians. The form begins with basic information which includes the child’s name, date of birth and parent/guardian name as well as the doctor’s name.
The main section lists the child’s medical condition along with recommended treatments and potential risks if treatments are not pursued.
The form concludes with a declaration of parental responsibility acceptance together with signature areas for both the guardian and physician.
5. Pediatric AMA Form (Color)
This template shares similarities with our third design but targets young patients through its updated minimalist format.
Our design eliminates unnecessary table lines to produce a simplified view which is gentle on the eyes and easy to read.
The colors can be quickly customized to align with your clinic’s theme or personal taste. We chose soft blue-green headers to create a calming aesthetic.
6. Psychiatric AMA Form
Psychiatric AMA cases require additional legal attention and comprehensive information about the patient’s mental health status.
The form contains a Mental Status table which allows the doctor to indicate whether the patient is alert, confused or unable to decide. It also includes a part that documents potential dangers such as self-harm.
The form concludes with a formal legal statement and contains signatures from the patient along with those of the psychiatrist and a neutral witness.
7. Psychiatric AMA Form (Color)
This form is just like the template above, but with a modern and minimal design.
8. AMA Form with Legal Waiver
The form works best when addressing serious situations such as patients who refuse surgical treatment or suffer from contagious diseases.
The form contains a legal waiver which prevents the patient from holding the hospital accountable.
Hospitals and legal teams looking for additional protection should use this form.
9. Emergency Room AMA Form
This AMA form is designed for patients who depart the ER without receiving treatment.
The form details the emergency diagnosis along with the visit time and recommended treatment before outlining the potential risks if treatment is not received.
It uses straightforward urgent language and includes signature spaces for the patient, doctor and a nurse or witness.
10. AMA Form for Home Healthcare Patients
The form targets home care providers such as nurses and physical therapists along with hospice workers who deliver services at patients’ homes.
We placed fields for Address and Home Health Agency Name at the top because patients receive care outside of traditional clinics with their Nurse/Provider Name included.
The form includes a section to document the patient’s condition and proposed treatment plan as well as potential risks associated with stopping home treatment.
Next comes a strong patient statement which shows that the patient understands the risks and declares that the provider or agency bears no responsibility.
11. AMA Form for Home Healthcare Patients (Color)
This form mirrors the previous one but we opted to enhance its appearance by removing side borders from the table and applying a soft blue-green color to the header using our minimal design approach.
