HIPAA Secure Patient Registration Forms Online

We create secure forms online for doctors’ offices and hospitals. We convert any paper forms
filled by patient into secure online forms, which can be filled, signed and submitted securely online.

Some types of forms we developed for our clients

Patient Registration form

Patient Questionnaires

Authorization forms

Secure Contact forms

How it Works

	Email us at info@mdofficemail.com your paper forms you wanted online
	We will design your form and send it to you for approval
	If you like it, we will host it on our secure HIPAA compliant server
	We will send you a link which you can place on your website*
	Patients will fill, sign and submit the forms
	Receive completed forms in your email as PDF
	If you do not have a website, we can make that for you
	Forms are smartphone friendly

Advantages

Save patient waiting time
Save Checkin Time
Accommodate more patients per day
No need to scan paper forms
Save 100s of hours of front office labor every month
Secure and HIPAA compliant
Highly customizable to match your website.
Customized fields as per your requirement including text fields, drop-down menu, check boxes, radio buttons etc.
Sub-menus with conditional display can be configured.
Responsive. The size of the screen displaying the form is detected and the design is customized for that specific device..
Attachments can be sent.
Captcha for spam prevention.
No installations to be made in your website except adding the hyperlink. No certificates and no hassle.

Pricing & Signup

Secure Form for your website. Dynamic and Responsive. Customized fields, design, your own banner/ logo. Hosted in our secure server.	Requires MDofficeMail email account to receive submitted form data. Submitted form data is received in the email body	$ 6.30 / form / mo (with annual subscription) $7.00 /form/mo (with monthly/quarterly subscription)
	Receive submitted form as PDF attachment in email Requires MDofficeMail email account to receive submitted form data.	$ 13.49 /form/mo (with annual subscription) $14.99 /form.mo with monthly/quarterly subscription)
	Receive form in PDF and also data excel format Requires MDofficeMail email account to receive submitted form data.	$ 16.49 / form / month (with annual subscription) $18.32 /form /month (with monthly/quarterly subscription)
Form development and setup charges (onetime)	(form with less than 10 fields)	$ 20.00 (one time charge)
Development of additional fields in the form (onetime)	(one time charge)	Please contact us.
Secure Web-contact Form SIGN UP