Secure Forms
Lose The Paper, Ditch The Fax

Save Money | Save Time | Save Postage | Save Paper

Mediprocity secure forms is a HIPAA compliant web and PDF forms system that allows you to create, share and save and return later legally binding forms for admissions, new patient registrations, employee hiring and so much more!

Limited in your recovery efforts because of improperly completed forms?

Victim of lost revenue because of a lost claims case due to a contract issue?

Spending time with legal during collections chasing documentation?


Features at a Glance:

  • Forms can include full branding and white label
  • Embedded dates
  • Ink signatures
  • Form archive and retention
  • Save & Return
  • Fully responsive to view and use on a mobile phone
  • Success and error pages
  • Single or multiple recipients
  • Data exported as PDF, XML, SQL, SFTP



Admissions Example Advanced Directives Example Form


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DO NOT add any patient health information here. We will follow up with you to discuss any PHI or security credentials. DO NOT share any PHI or any credentials in this help desk ticket. Thank you!

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How Do Forms Work?

Build your custom form which creates a dedicated link that can be emailed to anyone or converted as a button on your website. All of your data is returned in a completed PDF to your Mediprocity secure messaging account. Check our tutorial on how secure forms works CLICK

Get in Touch

  Mediprocity Inc.
714 Spirit 40 Park Drive
Chesterfield, MO 63005