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HIPAA Compliant Forms
HIPAA Compliant Forms

HIPAA / Web Forms

Improve your workflow and enhance security with HIPAA compliant forms

Jelly Websites can build HIPAA compliant forms that allow you to collect patient and other sensitive information anytime, anywhere, from any device. By allowing patients to securely fill out their secure healthcare forms right from your website, your office will reduce manual entry, eliminate paper waste and increase efficiency.

Let us help you improve your patient or client intake process by creating custom and secure healthcare forms. Our forms are custom and always up to date with latest healthcare information that you need for your practice.

Getting started is easy!

Step 1. Account Set-up

Just complete this online order link and we will get your account set up for our forms package. Order Today!

Step 2. HIPAA Forms Creation

Jelly Websites will create your custom forms with either forms you send to us or we can modify forms we have on file. Development is usually within 1-2 business days.

Step 3. Add Forms To Your Website

There are 3 ways to add your forms:
1. We will automatically add them to our existing clients’ websites
2. We can send you the necessary code that you can send to your website company to add to your website
3. If you have login access to your website, we can add the forms to your website for you.

Once the forms have been added to your website, your patients can start using them.

Step 4. Receive Form Submissions

When someone submits their information through your HIPAA compliant form, you will receive a notification via e-mail that a submission has been made. From there, you can log into the secure server to retrieve the data.

Step 5. Print or Export Form Submission Data

Protected Health Information, or ePHI, can be exported from your Google Drive dashboard in multiple formats including pdf, csv or xls. You can also print submissions to pdf or to your office printer.

Packages

Level 1

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1 HIPAA Compliant Form

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$20 per month

$50 one-time account activation

Level 2

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3 HIPAA Compliant Forms

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$40 per month

$50 one-time account activation

Level 3

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6 HIPAA Compliant Forms

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$60 per month

$50 one-time account activation

If you have more than 6 forms, please contact our Marketing Director for custom packaged pricing (951) 547-2007.