formisoft

Superbill / Encounter Form

Asks about date of service, insurance information, and rendering provider. Built for small medical practices capturing charges at the point of care.

Questions
15
Pages
2
Time
about 4 min

Includes

  • E-signature
  • Insurance details
  • Card payment
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Your practice

Superbill / Encounter Form

Page 1 of 2 · Your information

Insurance Information

Live preview. Tap through it like a patient.

Who it is for

  • Small medical practices capturing charges at the point of care
  • Specialty clinics standardizing CPT and ICD-10 documentation
  • Outpatient rehab centers tracking units of service per encounter
  • Billing teams reducing claim denials through accurate charge capture

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What's inside

Before you publish: Review amounts, payment terms, and authorization wording for your practice before sharing.

Page 1 · Your information

  1. Patient NameText · Required
  2. Date of ServiceDate
  3. Insurance InformationInsurance Info
  4. Rendering ProviderText
  5. Place of ServiceLong Text

Page 2 · Additional details

  1. ModifiersText
  2. Units of ServiceNumber
  3. Copay CollectionPayment
  4. Authorization NumberText
  5. Referring ProviderText

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 Superbill / Encounter Form, 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.

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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 15 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 Superbill / Encounter Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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