New Patient Form Example
We solve paper problems
Paper is expensive! Document related activities consume 15% of a company’s annual revenue.
Awesome web forms
This is an example of a typical web form we build for Health Practices’ new patient paperwork. Patients can easily fill out a form online before they arrive for their appointment.
Completed forms you are familiar with
After having patients fill out an online form, the document is saved and stored as a PDF document that looks exactly like the paper forms healthcare offices are used to.
Because paper is no fun!
- Do patients miss a field or section?
- Hard time reading someone’s handwriting?
- Asking patients to print paper at home?
- Mailing paperwork?
- Expensive – Avg 15% of a company’s revenue
- Hard to store and find
- Environmentally Harmful
Secure web forms
- Fill and submit paperwork at home
- Pre-certify your patients
- Enter patients into system before they arrive
- Reduce cancellation rate
- Improve scheduling
- HIPAA Compliant
- SSL Security
- Forms are always encrypted
- SAS 70 Type II and PCI Compliant Datacenter
We make it easy
- Use your existing paperwork
- Fits within existing workflow
- We build your web-form and pdf
- Affordable – Our platform allows us to easily build web forms fast. We pass the savings on to you!
- Fast – Get a solution in two weeks!
Let’s do it!
What happens first
- Send us a copy of your new patient paperwork
- Complete a signed Business Associate Agreement
- We put together a Form Design Proposal
- One time Form Design – Average of $99/page
- Monthly Subscription – $50/month