Patient intake that moves - HIPAA-aware, insurance-ready, EHR-compatible
Paper intake stacks up. PDF intake creates handoff errors. Generic online forms aren't HIPAA-friendly and don't fit how medical history actually branches. Your front desk ends up retyping fields into the EHR and still misses things.
- 4 Forms
- 4 Emails
- 4 Workflows
- 4 Integrations
- 3 Extras
Plus: Translated intake (English + Spanish), Mobile-first design tested on phones and tablets, Printable summary for patient's personal records
Installed in your Jotform account.
You own everything. No monthly fees to me.
How this kit actually works.
A Jotform-built intake workflow that collects history, medications, insurance, and consent in one branching form - with HIPAA-compliant storage, insurance-card upload, e-signature, and export structure ready for the major EHRs. Configured by someone who shipped Jotform integrations at the source.
Every piece, ready the day you buy it.
Forms
- Multi-section intake with conditional branching by condition
- Medications, allergies, and history section with dynamic fields
- Insurance capture with front/back card upload
- Consent form with legally-binding e-signature
Emails
- Confirmation to patient with pre-visit checklist
- Internal notification with structured summary for front desk
- Insurance verification reminder if card missing
- Pre-visit reminder 24 hours before appointment
Workflows
- Automatic flagging of drug interaction or allergy conflicts
- Insurance card routing to verification inbox
- Consent expiry tracking for returning patients
- Audit-trail notes on every submission
Integrations
- HIPAA-compliant Jotform Enterprise or HIPAA-plan storage
- EHR-ready structured export (CSV or JSON)
- Google Drive or Dropbox for encrypted file routing
- PMS handoff via webhook
Extras
- Translated intake (English + Spanish)
- Mobile-first design tested on phones and tablets
- Printable summary for patient's personal records
Pick the fit. Upgrade later if you need to.
Base Kit
Ready to run, self-setup
$149
- All forms, emails, and workflow configs
- HIPAA setup documentation
- 30-minute video walkthrough
- 14-day email support
Pro Setup
Kit + setup call + customization
$279
- Everything in Base
- 60-minute setup call
- HIPAA compliance checklist review
- Insurance routing and EHR export configured
- 30-day email support
Done-For-You
Full implementation by me
$649
- Everything in Pro
- Full implementation in your HIPAA Jotform account
- Front-desk staff training session
- Custom EHR integration setup
- 90-day priority support
The questions I get before someone buys.
Is this actually HIPAA-compliant?
The workflow is designed for HIPAA compliance when deployed on a Jotform HIPAA plan (Gold or Enterprise with a signed BAA). The kit includes the checklist, form-level settings, and storage configuration required. You also need your own signed BAA with Jotform - the Pro and Done-For-You tiers walk you through it.
Does this work with my EHR?
The kit exports in structured CSV or JSON that most EHRs accept. For direct API integration with Epic, Cerner, Athena, or similar - that's scoped into the Done-For-You tier.
What if a patient doesn't finish the form?
Jotform auto-saves drafts. The workflow sends a resume link if the patient abandons mid-form, and front desk sees partial submissions so you can follow up.
Do I need a Jotform HIPAA plan?
Yes. HIPAA compliance requires the Gold HIPAA plan or Enterprise. You can get a discount through our partner link - but do not deploy PHI workflows on standard plans.
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Not sure if this is the right kit?
Free 20-minute call. Tell me what you're trying to do - I'll tell you if a kit fits, or if you need something custom, or if you shouldn't pay me at all.