Give parents and guardians the freedom to complete the Pediatric Symptom Checklist with any device, anywhere. Enable them to answer sensitive questions in privacy at a comfortable and unhurried time.
Easily personalize this form template with our HIPAA compliant form builder.
Start saving time and money with FormDr
This form enables parents and guardians to express the changes they are seeing in their child’s behavior, emotions, or learning. Because parents/guardians know their children best, this is vital information for the provider to form a plan of care for the child.
A child’s daily functioning is an expression of their strengths and stressors. A child’s functioning is the common pathway for the influence of genetics, their psychological development, social determinants of health, coping abilities, and resilience.
The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.
A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.
Emailing new patient intake forms risks the interception of PHI. FormDr is HIPAA compliant, all patient data is encrypted in transit and rest. A Business Associate Agreement is included with your account.
All PHI is encrypted in transit and at rest—while being submitted back to your account and at rest in our database. Protect sensitive data with fully encrypted patient submissions.
Send a prefilled contracts, agreements, and forms to have patients securely sign forms customized for them. Create financial contracts with pricing specific to the patient.
Analyze data, improve patient responses, learn from patient behavior and raise your conversion rate. FormDr is the only tool you require to understand the needs of your patients.
Not having an online custom form to offer patients was a huge struggle. FormDr makes paperwork seamless and saves a ton of time and money by allowing us to upload to patients EMR rather than print, fill out, scan, and then attach. That is now a hindrance of the PAST!
Patients can fill out the forms at their leisure, and don’t have to print anything. We’re collecting more completed forms than ever, and patients love not having to do anything when they come to the office for the first time.
FormDr allows me to send and receive attractive, professional forms from patients. Very helpful that I can remind patients of their appointment time and check the status of the form.
Sending a PDF was too time consuming for the patients to do, and it required the additional steps of printing and scanning it into our own systems. FormDr made it easier to get patients to complete the forms by email, and it’s a more secure way to provide info than simply emailing back a completed PDF.
Before FormDr, the most common struggle were our patients taking a long time to complete forms in our office. Now patients are able to be seen faster when forms are completed prior to visit. Very easy service to create forms online!
The support is second to none. FormDr has been instrumental in streamlining our intake of new patients.
Before, clients weren’t signing our forms before the appointment. FormDr has allowed us to share our documents for client review and signatures. I really appreciate the support, it has been super helpful simplifying our forms!
FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:
