Square Healthcare Forms

Securely collect medical data and fee payments online with Square and Jotform.

The first 10 payments every month are FREE.
Paid plans start as low as $39/mo
https:// www.jotform.com
Jotform Square Payment Form
Full Name
My Products
Medical Mask
Medical Glove
Credit Card Information
Your payment is received with

All-in-One Medical Form Builder

Create forms that facilitate HIPAA compliance to collect health data, schedule appointments, receive informed consent, conduct surveys, collect bill payments, and more.

Build Your Medical Form

Build Your Medical Form

Use our drag-and-drop Form Builder to create forms that help you comply with HIPAA for your healthcare practice.

Add Square

Add Square

Select Square from the list of payment gateways and connect your Square account.

Treat More Patients Faster

Treat More Patients Faster

Start collecting important patient information and payments online!

Secure Medical Payments

Accept Bill Payments with No Extra Fees

Jotform never charges additional transaction fees for collecting money through your forms. You just have to pay the standard Square rate.


Put patients over paperwork with Square, the payment gateway trusted by healthcare businesses around the world. By making it easier to accept online payments for medical treatments and prescriptions, Square takes care of business for you and assists your practice with HIPAA compliance — so you can focus on connecting with and treating your patients.

When you integrate Square with Jotform, your healthcare organization can seamlessly process medical payments online, without paying Jotform any additional transaction fees. And if you’re worried about protecting patients’ payment data online, both Jotform and Square offer PCI compliance — keeping your online transactions safe and secure.

To take advantage of Jotform’s HIPAA compliance features, you must first upgrade to a Gold plan and sign a Business Associate Agreement (BAA). Then you can use one of our free form templates or create a form from scratch to build forms that enable HIPAA compliance. Embed the form in your website, or share it with a link.

This Dentist Uses Jotform & Square to Get Paid Quickly

This Dentist Uses Jotform & Square to Get Paid Quickly

Dr. Cynthia Brattesani owns a top dentistry office in San Francisco. To keep her practice running, she needs to get paid. She used to collect payments through paper statements, but knew there had to be a better way. That’s when she started using Jotform and Square.

Build Your Own Payment Form

Create an account and start receiving payments!


Get professional solutions with Jotform Enterprise

Discover how Jotform Enterprise can benefit your organization. Automate, collaborate, and scale with ease.

Contact Sales Learn More