Health information shouldn't travel by ordinary email.
HIPAA-conscious intake forms
Intake forms that send information through an encrypted, HIPAA-conscious service with a signed business associate agreement in place, instead of an ordinary contact form.
Price
$795 setup + $45/mo
Fixed and written into your proposal before any work starts. No hourly surprises, no long-term contract.
Add this to a full estimate
What it is
In plain words.
An ordinary website contact form emails whatever a visitor types, in plain text, through ordinary email. That is not a safe way to receive health information. This add-on replaces it with an intake form that sends submissions through a service that encrypts them and will sign a business associate agreement (BAA), the contract HIPAA expects when a vendor handles protected health information for you.
'HIPAA-conscious' is deliberate wording. A form is one piece of compliance, not all of it. Your practice also needs its own policies, training and safeguards, and we can't certify or guarantee compliance for you. What we can do is build the form the right way and be clear about what remains yours to do.
A good fit if
- Medical, dental, counseling, therapy, chiropractic and wellness practices that collect patient information online.
- Practices still using a plain contact form for new-patient questions.
- Practices that want patients to fill in intake forms before arriving.
Probably not for you if
- You don't collect any health information through your website.
- You're looking for someone to certify your practice as HIPAA compliant. That takes more than a form, and your compliance advisor or attorney is the right person for it.
We'd rather tell you so than sell you something that doesn't fit.
What you get
Exactly what's included.
An intake form built for your practice
The fields and questions you need, in a layout that's easy on a phone.
Submission through a provider that signs a BAA
You sign the agreement with the form provider, and we walk you through it.
Encryption in transit and at the provider
Submissions are sent over a secure connection and stored with the provider, not in ordinary email.
Notifications with no health details in them
You get an alert that a submission arrived. The information itself stays in the secure dashboard.
Placeholders for your consent and privacy wording
Your own counsel supplies the legal text. We put it where it belongs.
Written notes on how it's set up
A plain-language record you can keep with your compliance paperwork.
How it goes
We choose and set up the provider with you
One that signs a BAA. You sign it.
We build and test the form
Including how submissions and alerts behave.
We hand you the notes
What it does, where the data lives and what you still need to cover.
Why it's worth it
What it does for you.
Health information stays out of plain email
That's the point of the whole add-on.
Intake before the visit
Patients arrive with the paperwork done.
Fewer paper forms
Less re-typing from clipboards into your system.
A clear paper trail
You can show what you set up and why.
- The honest reason to buy this isn't speed. It's to stop putting health information into ordinary email.
Run your own numbers
Example figures. Change them to yours.
Count your intake time. These are example numbers: change them to your own.
Use what you'd pay someone for that hour, or what the hour could earn you.
- Staff time you get back3.5 hours a month at the rate you entered
- $88
- This add-on's monthly fee
- −$45
Net each month
$43
That would repay the $795 setup in about 19 months, and about $510 a year after that.
What this assumes
- The time estimate is yours, not ours: change the numbers until they match your week.
- It counts time only. It doesn't count the cost of getting privacy wrong, which is the bigger reason to do this properly.
The practical bits
What it takes.
What we need from you
- The information you need to collect at intake.
- Your consent and privacy wording, from your attorney or compliance advisor.
- Your agreement to sign the BAA with the form provider.
- Who in your practice should receive submissions.
How long it takes
Usually two to three weeks, including setting up the provider and testing.
Timelines are typical. The dates for your project go in your proposal.
What the monthly fee covers
The monthly fee covers hosting the form, keeping it updated and supported. A form provider's own subscription, if one applies, is separate, and we'll tell you the price before you commit.
Questions
Likely questions, answered.
Is it HIPAA compliant?
No product on its own is. This is built to be HIPAA-conscious: encrypted, with a BAA in place. Your practice is responsible for its own policies, training and risk assessment. Ask your compliance advisor or attorney what else you need.
What is a BAA?
A business associate agreement is a contract between you and a vendor that handles protected health information on your behalf. HIPAA expects one to be in place.
Who signs the BAA?
You sign it with the form provider. We help you through it, but it's an agreement between you and them.
Where do the submissions live?
With the form provider, in their secure dashboard. We design it so they're not sitting in ordinary email.
Does it replace my contact form?
For anything involving health information, yes. You can keep a general contact form, but with a clear note not to include health details.
Can patients upload documents?
Documents are covered by secure document exchange, which is designed for that.
Does the provider cost extra?
Some HIPAA-capable providers charge their own subscription. We'll tell you the price before you commit.
What does HIPAA-conscious intake forms cost?
$795 setup + $45/mo. The price is fixed and written into your proposal before any work starts, so there are no hourly surprises. If you ask for something that isn't in the proposal, we quote that change first and nothing changes until you agree.
Do I own it?
You own what we build for you: the code, the content, and the accounts it runs on (the domain, the hosting account and any service account, such as a payment account, are opened in your name). There is no proprietary platform to be locked into and no cancellation penalty.
Can you add it to the website I already have?
Add-ons are built into a ZONA site. If you already have a site, tell us what it's built with when you get in touch. We'll tell you honestly whether this can be added to it or would work better built into a new one. We'd rather say so than sell you something that doesn't fit.
How do I get started?
Use the button on this page to add it to your project, or send a message. A discovery call takes about fifteen minutes (no pitch deck), and then you get a fixed-price proposal. You'll hear back within one business day.
Is there a long-term contract?
No long-term contracts is our standing rule: care plans are month to month, and any monthly terms for an add-on go in writing in your proposal before you sign anything.