Never miss the call that needed a message.
Lydoh answers your practice's phone day and night and sends your staff a summary of every call.
Free template
A good phone message says who called, about which patient, how to reach them, what they need, whether they say it is urgent, and who took it. Print the form below, two to a page, or copy it into your EHR's telephone note. It works the same for dental and veterinary offices.
By the Lydoh team. Published November 10, 2026.
The form
Phone message
Your practice name
The call
Who called
What they need
What happened next
Confidential: file in the patient's record. Do not leave at the front desk.
Why each field is there
The patient-safety fields follow malpractice carrier guidance: MLMIC lists the patient, the caller and their relationship, the date and time, the reason, and any advice given as what call documentation should include1, and MagMutual advises attaching the slip to the medical record2.
Filled in
Names and numbers are made up. Notice that each one quotes the caller instead of diagnosing.
Privacy
A phone message is protected health information the moment it names a patient. HIPAA's minimum necessary rule requires a practice to limit each staff member's access to the information their job needs3, which for a phone message means three habits:
Ask before leaving details on voicemail; the form's "OK to leave a message?" field is there so the person calling back doesn't have to guess. For how to word the voicemail itself, see our reminder call script.
After hours
The form only works when someone is there to fill it in. MLMIC advises that after-hours calls be documented in the patient's record like daytime ones, that an answering service be checked periodically for accuracy and proper recordkeeping, and that voicemail alone is not recommended, because patients don't always understand that no one will call back1.
Disclosure: this is the gap Lydoh fills. It answers every call on your number, takes appointment and refill requests for your staff to confirm, writes a summary of every call, sends emergencies to 911, and reaches the provider on call when an after-hours caller says it is urgent. It never gives medical advice. The form above is free either way. See how after-hours answering works, or read who may triage the calls a message slip records.
FAQ
The date and time, who took it, the caller's name and relationship to the patient, the patient's name and date of birth, a callback number (and whether it is OK to leave a message there), the reason for the call in the caller's own words, the type of request, whether the caller says it is urgent, who it was routed to, and what was done about it. MLMIC's after-hours guidance lists the core of this: patient, caller and relationship, date and time, reason, and any advice given.
Identify the caller and the patient first, with two identifiers such as name and date of birth. Confirm the callback number and ask whether you may leave a message there. Write the reason in the caller's words, ask whether it is urgent, and tell anyone describing an emergency to hang up and call 911. Read the message back, tell the caller who will call back and roughly when, and route it to that person right away.
Clinical ones should. MagMutual advises that a telephone message slip with the documented advice and decisions be securely attached to the medical record, and that any separate call log be kept as securely as the record itself. Most EHRs have a telephone encounter note for this, so a paper slip is a stopgap, not the record.
No. The person taking the message records what the caller says and routes it; deciding what the symptoms mean is clinical judgment, which belongs to a licensed clinician. That is why the form asks for the reason in the caller's own words and whether the caller says it is urgent, rather than the receptionist's assessment.
Paper is allowed, but the slip holds protected health information, so it has to be handled like it. The Privacy Rule requires practices to limit each staff member's access to the information their job needs. In practice that means writing only what the person returning the call needs, never leaving slips on the front counter, and filing or shredding them once the message is closed.
A phone message template is one form per call, which travels to the person who will act on it. A call log is one running list of every call in order, useful for proving when a call came in and was returned. MagMutual suggests a chronological log can help resolve disputes about calls. Many offices use both: the slip for action, the log for the record.
The form and examples are ours, free to print, copy and adapt. Sources checked November 10, 2026. This page is general information, not legal or clinical advice; check your state rules and your malpractice carrier's guidance.
Keep reading
Lydoh answers your practice's phone day and night and sends your staff a summary of every call.