01
Patient submits
On a phone, in their own time. Nobody on your team is chasing paperwork or reading handwriting.
HIPAA-compliant intake for healthcare teams
10x the patients.Same size team.That's the plan, right?
Patient intake that arrives in your EHR already done. Eligibility verified, appointment booked, chart updated, before anyone on your team opens a laptop. We build it, we run it, you're live in a week.
No card, no contract, and no obligation to like it. We build your real intake flow first, then you decide.
- Signed BAA on every account
- PHI encrypted in transit and at rest
- Native Healthie integration
- Real-time eligibility checks
fastform / builderReading your request
01 / Describe itplain english
Branching, payments, e-signature and the EHR write are inferred. You do not wire them.
- Reading the request
- Building the flow
- Applying your brand
- Publishing
02 / It builds itself0 fields
Untitled clinicdraft intakePublished
Empty canvas. Tell it what you need on the left.
PHI encrypted in transit and at rest
Live at intake.northgatefamily.comA demo of the builder. Yours starts from your words, not ours.
01 / The hinge
The form is the easy half.
Anyone can put questions on a screen. The question that separates vendors is what happens the second a patient hits submit. If the answer involves somebody retyping a PDF into the chart on Monday, you have already found the reason to switch.
The DIY version of this is a form builder, an automation tool, and whoever wires them together and keeps them wired. Here it is one description, one vendor, one BAA, and one thing to maintain.
02 / After submit
Submit is where the work starts. Ours, not yours.
Four things happen before anyone on your team opens a laptop. None of them involve a person, a fax, or a business hour.
02
Eligibility verified
Clearinghouse-verified in real time, before a slot gets taken. Coverage is answered first.
03
Appointment booked
With the right provider, because the flow already asked the questions that decide that.
04
Chart written to Healthie
A native integration, not a CSV export somebody re-imports on Monday morning.
You have a form. You do not have a pipeline.
that is the whole difference03 / White label
Patients see your clinic. They never see us.
Published forms are white-labeled: your logo, your colours, your domain. Mobile-first, because this gets filled in on a phone in a car park, not on a desktop in your lobby.
Try a brand colour
This is fastform, and you would not know. Neither will they. The only place our name shows up is on your invoice.
Northgate Family Healthintake.northgatefamily.com
Question 2 of 5
Are you using insurance for this visit?
Yes, I have a cardNo, paying myselfI am not sure
Continue
Encrypted in transit and at rest
Live preview, persimmon
04 / Drop-off analytics
Which question loses them?
Most teams cannot answer that about their own intake. You will be able to, on the day you go live, question by question, without hiring an analyst to tell you.
The bars are coloured by field type, the same vocabulary the builder uses. When a specific question is costing you patients, it stops being a hunch and starts being a rectangle.
Completion by questionExample view of the product. Sample data, not a customer result.
Reason for the visit
Legal name and date of birth
Contact details
Medical history
Current medications
Insurance card, front and back
Consent to treat
Pick an appointment
Submitted
Questions that branchPatient detailsUploadsE-signatureScheduling and paymentBiggest single drop
Illustrative shape only, drawn to show what the view looks like. Your chart is drawn from your own patients, and you have it in week one.
05 / Pricing
Four numbers. All of them on this page.
We're not going to hit you with a pricing calculator that requires a PhD. HIPAA and a signed BAA come on every tier, including the $45 one, because compliance is not the upsell.
Annual is optional everywhere, at eleven months of monthly. Never forced, never preselected.
One flow, done right
For a single practice getting its first intake flow right.
- One build a month, extra builds $39
- Unlimited edits
- White-labeled publishing
More flows, one vendor
For a practice running new patient, telehealth and follow-up separately.
- Two builds a month, extra builds $35
- Unlimited edits
- Drop-off analytics on every flow
The full loop, wired by you
Eligibility, payments, e-signature and the Healthie write, run by your team.
- Four builds a month, extra builds $29
- Unlimited edits and unlimited usage
- Real-time eligibility and native Healthie sync
We build it, we run it
You describe what you need. We keep it built, wired and working.
- Eight builds a month, extra builds $25
- Unlimited edits, we make them
- Seven days from signature to live
We'll build yours free.
A build is one flow built or rebuilt from your description. Edits to a flow you already have are unlimited on every tier, so getting the wording right does not cost you anything. Price the DIY version first: a form builder, an automation tool, and whoever keeps them wired. Then compare.
06 / Questions
The short answers.
Is this actually compliant?
Yes, and you do not have to negotiate for it. A signed BAA comes on every account, on every tier, including the $45 one. PHI is encrypted in transit and at rest. You do not need a compliance hire to turn it on, and you do not have to sit through an enterprise sales cycle to get the paperwork that makes it legal.
We already have custom forms. Why switch?
Because you have a form, and what you actually need is a pipeline. Ask your current setup what happens the second a patient hits submit. If eligibility, booking and the chart write all still involve a person, the form was never the expensive part.
Who is this not for?
Solo practitioners. The economics do not work for you, and a simpler tool will serve you better. Also not for organisations past about 200 providers that already have a platform team: you have the people to build this in-house, and you will want to.
The fit is multi-provider practices where the front desk is the bottleneck and there is nobody whose job is wiring software together.
How long until we are live?
Seven days from signature. That is a commitment we make, not an average we measured. If we cannot hold it for your flow, we will tell you before you sign rather than after.
Do patients ever see fastform?
No. Published forms carry your logo, your colours and your domain. There is no badge in the corner of anything. The only place our name appears is on your invoice.
What does "a build" mean?
One flow built or rebuilt from a description you give us. Changing the wording of a question, reordering a step or adjusting the branching is an edit, and edits are unlimited on every tier. We count builds because that is the unit a practice manager can actually plan around.
We'll build yours free.
Tell us the intake flow you actually need, in plain English. We will build the real thing, on your brand, with your branching, and show it to you working. If it is not obviously better than what you have now, you have spent twenty minutes and nothing else.
No card. No contract. BAA signed before anything real is touched.