formisoft

HIPAA Consent & Authorization

Asks about I have read and understand the notice of privacy practices.. Built for all healthcare practices subject to HIPAA.

Questions
6
Page
1
Time
about 2 min

Includes

  • E-signature
Use this templatePrint it instead

Your practice

Live preview. Tap through it like a patient.

Who it is for

  • All healthcare practices subject to HIPAA
  • New patient onboarding across all specialties
  • Annual HIPAA re-authorization
  • Telehealth and remote patient onboarding

What's inside

Before you publish: Add your practice-approved consent wording before publishing.

  1. I have read and understand the Notice of Privacy Practices.Toggle · Required
  2. I consent to the use and disclosure of my health information for treatment, payment, and healthcare operations.Toggle · Required
  3. Full NameText · Required
  4. Date of BirthDate · Required
  5. Today's DateDate · Required
  6. SignatureE-Signature · Required

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the HIPAA Consent & Authorization, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 6 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the HIPAA Consent & Authorization for your practice, ready to send before the next visit.

BAA included · We set up your front desk

Use this template