Secure Form Quote

Send us your paper forms and get a quote to transform them into secure online forms

The process to build a secure online form with us is simple.

  1. Decide what slow, tedious paper forms you are ready to convert to secure, online forms.
  2. Upload any slow, tedious paper form(s), in a .doc, .docx, .pdf, or .jpg format, using upload tool below.
  3. Answer a few questions about your forms and data access needs, below.
  4. For more complex forms, meet with us online for a brief walk-through of the details and your needs.
  5. Receive a quote from us that estimates the timeline and cost to convert your form(s).
  6. Or, if you are ready to order now, use our secure forms order form to get started with your build today. https://secure-forms.mediprocity.com/forms/e0553902
Upload your paper forms here

General pricing information

The starter level plan is $30/month for 1-3 forms
The standard level plan is $60/month for 4-20 forms
The enterprise level plan is $100/month for 21+ forms
All forms prices include:

  • Design to match your company’s branding
  • Legally-binding documentation and “ink” signatures
  • Save & return later feature
  • Mobile and tablet-friendly
  • PDF, XML, Excel, CSV, SQL formats and more

Here are a few examples of our most popular forms (click to view):

Covid Vaccine Administration
Covid vaccine consent
Flu vaccine order form