The 5 Critical Security Leaks in Your Digital Patient Forms - New Patient Systems Inc.

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The 5 Critical Patient Data Leaks on Your Digital Forms and Website

Download your complimentary report by clicking here.

Special expires 04/26/2024

0 days 23 hours left

Now Available - Low cost, More Secure and Signable Digital Patient Forms
Setup fee is waived
50% off
Guaranteed price match to any legitimate competitor offering

✔ Completely paperless.
✔ Higher level of security.
✔ Integrated and customized on your website (simple websites are available if you don't have one).
✔ Patients can fill out and sign from their phone, tablet or computer.
✔ COVID-19 Pre-screening forms (updated regularly).
✔ New Patient Forms.
✔ Medical History Forms.
✔ Any other special protocol forms you need can be built.
✔ Includes secure website management if needed.

Trusted by dental clinics for over 14 years.Protect yourself and your patients while offering them more secure, easy to use, attractive patient forms.

To take advantage of this offer before it expires, please continue below

Fill out the form below to email or call now 416-848-7581 x202 for a free technical checkup to see if your clinic qualifies.


        
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                                    What kind of forms do you want (check all that apply)?*
								
								COVID-19 Pre-screening
							

								
								New patient
							

								
								Patient update
							

								
								Medical history
							

								
								Other (Please specify below)
							
Other
What do you value most in having digital forms?*
								
								Compliance with social distancing
							

								
								Easy to use
							

								
								Save time
							

								
								Prevent patient data and security leaks
							

								
								Attractive looking forms
							

								
								Going paperless
							

								
								Save money
							

								
								Other
							
Other
                    
                    
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                        Tell us about your current patient forms
Please describe how you use your patient forms currently.*
Do you scan completed patient forms and store them on the computer?*
			
				
				Yes
			
			
				
				No
			
What do you do with the completed, scanned forms?
if you have blank forms available, please upload them here.
										
											Drop files here or 
											
										
									
Max. file size: 32 MB.
 

                    
                    
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                        Tell us about your website
Do you have a website?*
			
				
				Yes
			
			
				
				No
			
Secure digital patient forms require a website, even if it's a just basic website. Do you want us to help you with that?*
			
				
				Yes
			
			
				
				No
			
Do you want to have a low cost, basic website or an attractive, fuller one?*
			
				
				Just a basic website for now
			
			
				
				I want a nice looking website to educate and attract patients
			
			
				
				
			
Sorry, we are unable to help you at this time with digital secure forms if you do not have a website and also do not want one.
Do you use Wordpress for your website?*
			
				
				Yes
			
			
				
				No
			
			
				
				I don't know
			
			
				
				
			
How do you host your website?*
			
				
				Someone else hosts and manages the website.
			
			
				
				Webhost (like Godaddy, 1and1.com) hosts but someone else manages it
			
			
				
				Webhost (like Godaddy, 1and1.com) hosts but the clinic manages it.
			
			
				
				I don't know.
			
			
				
				
			
If your website is your house, you still need land to put the house on. That is your webhost. 
Do you manage your own domain name (www.yourclinic.com)?*
			
				
				Yes. The clinic owns and manages the domain name.
			
			
				
				No. Another company owns and manages the domain name.
			
			
				
				No. We own the domain but another company manages the domain.
			
			
				
				I don't know
			
			
				
				
			
Who controls your greatest online asset - your clinic's URL?
                    
                    
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                        Tell us about your computer network
Do you manage your own computer network ?*
			
				
				Yes.
			
			
				
				No. Another company manages our computer network.
			
			
				
				I don't know
			
			
				
				
			
Any other general comment or concern? Please write it out here
Tell us about you
Name*
                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Email*
                            
                        
Phone*
What is your preferred method of contact?*
			
				
				Email
			
			
				
				Phone
			
			
				
				Doesn't matter
			
Address*    
                    
                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        
                                        State / Province / Region
                                      
                                    
                                    ZIP / Postal Code
                                
                                        
                                        Country
                                    
                    
                
That's it! Just hit the submit button and we will conduct a tech checkup and contact you within 24 hours
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