secure web forms

Improve your workflow and enhance security with secure online forms

Jelly Websites can build secure forms for your website that allow you to collect customer or patient sensitive information anytime, anywhere, from any device. By allowing your customers to securely fill out your secure forms right from your website, your office will reduce manual entry, eliminate paper waste and increase efficiency. All forms we create for the healthcare industry are HIPAA compliant.

Never have dated forms again! The forms we create for you are custom, updated (typically the same day) when you have changes and are made in “real time” so updates show immediately.

online web forms

Getting started is easy!

Step 1. Account Set-up

Just complete the order form on the link below and we will get your account set up for your forms package.

Step 2. Secure Forms Creation

Jelly Websites will create your custom forms with either forms you send to us or we can modify forms we have on file. Development is usually within 1-2 business days.

Step 3. Add Forms To Your Website

There are 3 ways to add your forms:
1. We will automatically add them to our existing clients’ websites
2. We can send you the necessary code that you can send to your website company to add to your website
3. If you have login access to your website, we can add the forms to your website for you.

Once the forms have been added to your website, your patients can start using them.

Step 4. Receive Form Submissions

When someone submits their information through your online form, you will receive a notification via e-mail that a submission has been made. From there, you can log into the secure Google drive that we set up to retrieve the data.

Step 5. Print or Export Form Submission Data

All forms can be exported from your Google Drive dashboard in multiple formats including pdf, csv or xls. You can also print submissions to pdf or to your office printer.

Packages

Level 1

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1 Secure Online Web Form

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$20 per month

$50 one-time account activation

Level 2

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3 Secure Online Web Forms

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$40 per month

$50 one-time account activation

Level 3

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6 Secure Online Web Forms

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Customer Support

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Unlimited Submissions

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Unlimited Reports

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Electronic Signature

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reCAPTCHA code

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Custom Branding

$60 per month

$50 one-time account activation

If you have more than 6 forms, please contact our Marketing Director
for custom packaged pricing (951) 547-2007.