HIPAA Compliance
Assignment of Benefits
Collect authorization to assign insurance benefits directly to a provider or organization with the Assignment of Benefits form, so you can document consent clearly and keep claims moving.
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Background Check Authorization
Collect candidate consent for a background check during hiring and HR screening, and keep authorization details organized so your team can review them quickly.
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Botox Consent
Collect informed consent and medical acknowledgement for Botox treatment, including risks, benefits, and patient authorization, so providers can document a clear record before care.
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Consent to Treat
Collect patient permission to receive medical care and treatment with the Consent to Treat form, so staff can document authorization and move forward with care.
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Dental Clearance Form
Collect dental and medical approval details for patients before procedures or treatment with the Dental Clearance form, so providers can review readiness and move care forward.
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Dental Extraction Consent
Collect patient consent and acknowledgment for dental extraction procedures, risks, and aftercare with a clear Dental Extraction Consent form that helps dental teams document approval and next steps.
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Dental HIPAA Release
Authorize the sharing of dental records and protected health information with designated individuals or providers using the Dental HIPAA Release template for clear, documented consent.
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Dental Records Release
Collect authorization from patients who want their dental records shared with a designated person or provider, and keep release requests organized from start to finish.
PreviewDental X-Ray Refusal
Record a patient’s refusal of recommended dental X-rays and confirm they understand the risks with this Dental X-Ray Refusal template for clear documentation.
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Financial Responsibility
Collect patient agreement to financial terms, payment responsibilities, and insurance coverage details with the Financial Responsibility form for healthcare intake and registration.
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Home Health Compliance Checklist
Track agency compliance tasks and requirements with a detailed checklist for home health operations, helping teams stay organized and ready for reviews.
PreviewHome Health Referral
Collect patient and provider details with the Home Health Referral form to submit home health care referrals quickly and accurately for care teams and intake staff.
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Informed Consent
Collect signed consent and confirm participants understand the purpose, risks, and terms before proceeding with the Informed Consent form.
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Mental Health Referral
Collect referral details, patient history, and handoff notes in a Mental Health Referral form for counselors and care teams so the next provider can review the case quickly.
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Patient Intake Form
Collect patient details, medication history, existing conditions, and consent in one Patient Intake Consent form so your care team can verify information and start visits with confidence.
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Physical Exam
Collect health details and exam results with the Physical Exam template for clinics, employers, and other reviewers who need a clear record and faster follow-up.
PreviewPremedication Refusal
Collect patient acknowledgement and details when they decline recommended premedication before dental treatment, so your team can document the decision clearly and keep care moving.
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Therapy Consent
Collect client acknowledgment and consent for therapy services, risks, and confidentiality terms before treatment begins with this therapy consent template.
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Easily create forms to engage with your patients.
Patients expect to be able to communicate with their providers electronically, but security concerns make this difficult. Federal electronic medical records rules mandate electronic communications, but provide no solutions that are cost-effective.
Cognito Forms solves these problems by making it easy to build HIPAA-compliant forms for new patient registration, appointment scheduling, refill requests, patient satisfaction surveys and even online bill payment. All of these great capabilities are available, including unlimited forms and unlimited entries, to organizations on our Enterprise plan.
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Features
SSL Encryption
Your forms and data are accessed over HTTPS 100% of the time.
Data Encryption
Your data is secure and encrypted at rest.
Business Associate Agreements (BAA)
See our sample standard agreement.
Automatic System Logoff
After a period of inactivity, the system will timeout and automatically log you off.
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