100% HIPAA Compliant - Safe, Secure

Custom Online Patient Registration Forms

Save Your Practice TIME and MONEY With Online Patient Registration

Eliminate Wasted Office Time Go Paperless if Desired

  • If your prospective new patient cannot submit their forms electronically, you look out of touch and make a bad first impression. My office is more efficient and I have fewer new patient cancels or reschedules. This is truly a no-brainer.

    - Mark Hunt DDS Minneapolis, MN

Simple to use - Training Time is 15 Minutes

This software is simple and easy to use, yet sits behind state-of-the-art, HIPAA compliant
encryption and safeguards to guarantee your patient data is secure.

New Patient Satisfaction, New Patient Loyalty

Your custom HIPAA compliant online forms allow patients to complete and sign their forms from the convenience of a desktop, tablet or mobile phone. Even better, your office receives the forms immediately. This ensures a happy, more invested patient, a more efficient front desk, less new patient cancellations, and more practice revenue.

  • New patients who submit forms online are more invested in making their appointment
  • Reduce check-in time from 20-30 minutes, to 5 minutes
  • Virtually eliminate aggravating new patient cancellations or reschedules due to last minute insurance issues or medicine the patient takes
  • Electronic forms allow the new patient to fill out the forms in the privacy of their home, and where their insurance and medication information is kept. This makes the patient's life easier, as well as more accurate and complete forms.

Save Time, Save Money, See More New Patients

Did you know that nearly 67% of new patient cancellations occur due to inaccurate patient forms information? Typed forms are much easier to read and interpret than hand-written ones, reducing mistakes and errors, and saving clerical hours for the staff.

It's very important to know a patient's accurate health and medical history prior to their appointment. Patients don't always remember the name of their medication or even the dosages, when they are sitting in your office filling out the forms. Online forms provide staff with the opportunity to review and evaluate their information days in advance of their appointment and, if necessary, contact the patient for more or missing information.

  • Know the patient's medical history and medications days in advance of their appointment
  • Save staff clerical hours (and money) and increase office efficiency
  • Reduce new patient intake time - new patients are registered in 5 minutes, not 15-20+ minutes.
  • Typed forms are easier to read and interpret than handwriting
  • A link to the forms can be emailed or sent via sms to the new patient - a website is not required
  • If desired, go completely paperless
  • Easily and quickly import forms to your office EMR (Dentrix, Eaglesoft, etc.)

Want to Go Paperless?

With My Custom Forms you can eliminate the need for paper forms entirely. Your forms are already scanned and ready for upload into your EHR as attachments.

Appointment Cancellation Alerts

If the new patient has not submitted their forms 48 hours before the appointment date, this is a red flag to call them and confirm they are coming, and if necessary gives you time to fill the slot with a different patient.

HIPAA compliant

Fully HIPPA compliant, high end security with 24/7 monitoring, SOC II with 256 bit SSL encryption allows us to transfer patient information, as well as contact insurance companies electronically to acquire patient benefits information,and send the results directly to your office safely and securely.

With My Custom Forms, You Get

  • Personalized account creation and assistance
  • Free website implementation
  • Patients can submit forms using any device
  • Patients can sign all forms electronically
  • Forms customization - your forms will look exactly
    like your current forms (if desired)
  • Free training - usually takes just 15 - 20 minutes
  • Unlimited office staff access
  • 24/7 dedicated technical support
  • Customer Service - Email, Phone (toll free)
  • Free 30-day trial


SPECIAL OFFER - through April 30th, 2017, we are reducing our normal one-time setup fee from $299 to just $99 (for up to 6 forms). This fee covers the cost of converting your current forms, exactly as they now look, into electronic forms.

No term contract is required. Try online forms for 30 days free of charge - we are confident you'll stay with us when you see the benefits for your practice.

For Offices that average up to 50 new patients monthly 69.95/month
For Offices that average 51+ new patients monthly 89.95/month
Practices with multiple office locations - call for custom discount rates custom quote

Frequently Asked Questions

  • Is My Custom Forms HIPAA Compliant?

    Yes. We use state of the art, multi-layered security and heavy encryption that meet or exceed HIPAA standards. Our servers are managed 24x7, 365 and located in a SOC 2, Type II audited facility that is located in the U.S., with 256 bit SSL encryption.

  • Will My Custom Forms work with any website?


  • Do you use "Template" forms, or are they custom to match my existing forms?

    We do not use templated forms. We take your form, as is, and match it exactly. When you view and/or print the patient forms they will look exactly like your current forms, including color(s), company logo, etc.

  • How many forms can we use with your service?

    We allow up to 6 forms without any additional setup fees or monthly costs. Very few practices use more than 6 forms, but if they do, we will custom quote clients who require more than 6.

  • How does My Custom Forms work with our existing EMR/PMS?

    It's easy. You simply download the forms,which are already in .PDF format, and then upload them into your EMR/PMS (for example, using Smart Doc with Eaglesoft) and attach them to the patient record. Or, if your internal system accepts Excel format, we will export your forms data in Excel for uploading into your system.

  • Can multiple doctors use the same My Custom Forms account?

    Yes, if the doctors all practice at the same location. Multiple locations require a separate account for each location. We offer discounted rates for offices that require multiple accounts. Contact us for more information.

  • Can patients sign My Custom Forms using e-Signature?

    Yes, My Custom Forms accepts e-signatures. Any mobile device, mouse, or touchscreen device can sign our forms.

  • Does My Custom Forms work on mobile devices?

    Yes! In fact, that's one of the important reasons to transition from "patient must print, fill out, bring in" forms, to electronic forms. It's much more convenient for your new patients, especially those using mobile devices - which is pretty much everyone!