Building form...
New Patient Intake
Full Name
John Smith
Date of Birth
MM/DD/YYYY
Insurance Provider
Select...
Reason for Visit
Describe symptoms...
Submit Form
>"new patient intake with insurance"|
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BAA Included
SOC 2 Compliant
Audit Log Active
2024-01-15 09:23:41 - Form accessed
2024-01-15 09:24:02 - Data encrypted
2024-01-15 09:24:03 - Stored securely
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Fastform
EHR
CRM
Billing
Insurance
Data
Practice
Real-time sync
IntegrationsNative

Connects to Everything

EHR, CRM, billing, insurance — actually connected. Not "via Zapier."

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9:41
Patient Intake
Valley Health Clinic
Phone Number
(555) 123-4567
Preferred Contact
Text
Call
Email
Insurance Card
Tap to upload photo
Continue
89%
completion
MobileResponsive

Mobile-First Design

Works on phones. Because that's where your patients are.

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Form Analytics
Last 30 days
+24%
1,247
Submissions+12%
4:32
Avg. Time-18%
89%
Completion+24%
Drop-off Analysis
Start
100%
Contact
92%
Insurance
78%
History
71%
Submit
89%
Insurance step has highest drop-off. Consider simplifying or adding photo upload.
Live data
AnalyticsInsights

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See where patients give up. Fix that part.

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