Can I build my own/customize HIPPA Compliant Form(s)

  • Cynthia
    Asked on February 6, 2019 at 8:36 PM

    Add logo to form?

    Embed into website

    Notify customer that submission received? attach completed form?

    Notify office that submission completed? attach completed form?

    Custom Autoresponders?


    Have a client that needs a hippa compliant form for patient intake for new website (under development).  Small counseling firm - new 1 year old, growing - 1 owner, 5 therapists.

    All forms go to owner who redirects to appropriate therapist


  • Ashwin JotForm Support
    Replied on February 7, 2019 at 12:06 AM

    Add logo to form?

    Yes you can add logo in your HIPAA complaint form.


    Embed into website

    Yes you can embed your HIPAA complaint form in your website. The following guide should help you how to embed  form in your  webpage:  https://www.jotform.com/help/34-Adding-a-Form-to-a-Web-Page 


    Notify customer that submission received? attach completed form?

    Notify office that submission completed? attach completed form?

    Yes you can add auto-responder email alert in form to notify the customer that submission  is received. You can also add notifier to receive email that submission is received. Please note that if you want to include the form field data in email, you will have to disable protected field option in form. Please check the screenshot below:

    1549515620protected Screenshot 10

    You can enable PDF attachment in email alert as well. The following guide should help you:    https://www.jotform.com/help/503-How-to-include-submissions-as-PDF-attachment-in-the-email-notifications 


    Custom Autoresponders?

    Yes you can edit your auto-responder email template in form.

    Please take a look at the following demo form and submit it to receive auto-responder email:  https://hipaa.jotform.com/90369485932469