Building each form
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Form Conversion
$195 for up to three pages
Your form, ready for online use.
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Form Review & Build
$395 for up to three pages
A better form, built around your office.
HIPAA-compliant patient intake forms, built with you
Your first form is on us.
Send us an existing form of up to two pages and we'll turn it into a fully functioning online form, free of charge. Try it from start to finish: fill it in as a patient, submit it, and see what your office receives. No cost. No commitment.
When you're ready to use it with real patients, choose a service plan and sign a Business Associate Agreement with us.
How it works
Three steps, and most of the work is ours.
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Send us your form
A PDF, a Word file or a photo of the paper version all work. Tell us whether to email you or call you, and we take it from there.
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We build it
Exactly as it is, or improved with you if you'd like a second look. We check in with a few questions only your office can answer.
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Try it, then go live
Fill it in as a patient would and see what arrives. When you're ready, your form gets its own link for your website, your reminders or a tablet at the front desk.
Get your first form free
When you're ready to use it with real patients, choose a service plan and sign a Business Associate Agreement with us.
Why practices stay with us
We don't hand you a form builder and walk away.
You send the form and real people build it. And if you want more than a copy of the old one, we're the people to improve it with.
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Built with you, not by you
You send the form. We do the building, and we ask about the things only your office knows.
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Better forms, when you want them
Nobody puts "review our intake forms" on the to-do list. Form Review & Build is the natural moment to drop what nobody reads, add what your practitioners need, and fix what patients get wrong.
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People you'll get to know
You'll know who you're talking to, and it will be the same people next time. More like co-workers than a vendor.
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A decade of forms, and only forms
Healthcare forms are all we've done for more than ten years. We understand them better than anybody.
Two simple decisions
How we build it, and how we support it.
A one-time build fee per form, fixed before any work begins, and an annual service plan. The first form is free either way.
Building each form
Your service plan
Get your first form free
When you're ready to use it with real patients, choose a service plan and sign a Business Associate Agreement with us.
Security and HIPAA
Your patients' data is the whole point.
Completed forms reach your office by encrypted email or in your own portal, each practice's records are encrypted with a key used only for that practice, and we sign a Business Associate Agreement with every client before live patient information is processed. We've written down exactly how it works, for the person in your office who will ask.
Read how we protect it- Each practice's records kept apart and encrypted with a key used only for it
- A Business Associate Agreement with every client
- No patient information in your Direct Delivery account
Try one
Seeing beats reading.
Fill in a real Secure Form intake, or load our made-up patient in one click, and see the PDF your office would receive. Nothing you type leaves your browser, and there's no email to give.
Your first form is on us.
Send us a form of up to two pages. We build it free, you try it from start to finish, and there's no commitment. Have more forms? We'll scope the rest together.
Get your first form freeWhen you're ready to use it with real patients, choose a service plan and sign a Business Associate Agreement with us.