Features - HIPAA Email Secure Forms
Secure Online Patient Forms
Using a Secure Website Form to Protect Confidential Information
Using our Secure online patient form service you can collect confidential information including PHI of visitors/patients from your website with 256-bit SSL encryption and HIPAA compliance. No scripts or certificates to install for your website on your server.
A secure online form is necessary to collect Protected Health Information (PHI) and other sensitive, private information such as social security details, credit card details, legal information, etc. Encrypted and secure web form is not only mandatory to collect PHI but also gives confidence to the visitors of your website.
Free Designing and Configuring of Form
Don't waste your valuable time in designing and configuring. We do that for you. No extra charges!! Just select the design from samples, inform us the fields required by you. We will design, configure, host the form, and provide you with the link. Just a monthly flat fee for secure hosting.
HIPAA Compliant Secure Patient Forms Online
MD OfficeMail can build Secure, HIPAA Compliant Webforms that can be linked to your website. Patients can fill out these forms securely and transmit information to your office.
We build following forms:
Patient Questionnaires
Patient Consent Forms
Contact Us Forms
Authorization Forms
How MDOfficeMail Secure Contact Form Works
When a visitor to your website clicks the form link in website or email a secure form opens which is a HIPAA compliant. This is a web page in our secure server in which the information will be entered by the patient.
Once the completed form is submitted, all the collected information is converted into an email message and sent to the secure MDOfficeMail email account that is associated with the secure form. Filled in form can also be delivered as a .pdf or .xls document.
Features of MDOfficeMail Online Secure Form
Secure and HIPAA compliant
Filled in form can be delivered as a .pdf document
Very userful in case of consent forms, authorization forms etc
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
Forms can be signed online with real signature
No installations to be made in your website except adding the hyperlink
No certificates and no hassle.
Pricing & Sample Forms
What is the cost of Secure contact form?
Each customized secure web form costs starting from $7/mo. You need to have MDOfficeMail email account to receive submitted information. No designing or setup charges for forms with 10 or less fields.
Can I see a sample Secure contact form?
Click here to see a sample Secure contact Form. It is live. You can fill and submit it to see the functionality.
More samples are here: Sample-1, Sample-2, Sample-3, and Sample-4
What Is Needed to Have a Secure Contact Form for My Website?
It is very easy!
- Go to subscriptions/orderservices.aspx and place order
- Send details of fields and text required in the form.
- Send header and other images used in your website to be incorporated in the form
- Allow 4-24 hours for us to complete the process and send you the hyperlink code
- Hyperlink "Contact Us" or any other appropriate button in your website.
Ready for a Secure Form on Your Website?
Let us design, configure, and host your HIPAA compliant secure form — free of charge — for a simple monthly hosting fee.
View Plans & Price