ChiroUnchained Forms — new-patient forms your patients fill in on their phone

What you get

The full new-patient packet: the intake form (it asks about an accident or injury and shows the injury pages only when they apply), the privacy acknowledgement, consent to examination and treatment, and the financial policy
English forms, signed in the language they read. Spanish versions are an optional extra: $10, one time
Signed on the phone by typing the name or drawing it. The time of signing and the exact words shown are kept with the signature
Your own welcome page with your name, logo and your own video, so the patient sees your practice first
Every form as a PDF in your account, and an e-mail telling you forms arrived — with no patient information in the e-mail
A printable paper copy of the new-patient form, in both languages, for patients who want paper
A HIPAA Business Associate Agreement, included. You read it and accept it before you pay

How it works

1. Sign upAccept the agreement, pay, and choose your password on the next page. Then add your logo, send us your forms, and install the free Chrome extension.

2. Send a linkType the patient’s name and date of birth. Copy the link or let them scan the code.

3. Read what came backOpen the PDF of each form from your Received list, ready for your own records.

We convert your own forms

Upload your forms: PDF, Word, or a phone photo of the paper form. BLANK forms only — never a filled-in one.
We turn them into online forms (fields, checkboxes, fill-in areas and signature lines). If you added Spanish versions, we make those too.
You preview each form (English and Spanish side by side, if you added Spanish) and click Approve (or edit) before anything goes live.
Your consent and financial-policy wording is kept word for word. A Spanish version is machine-made until you approve it.

Your welcome video

You paste a YouTube link. It plays on your public welcome page only after a click, in YouTube’s privacy-enhanced player. Your patients’ personal form pages carry no video and nothing from YouTube. We do not host video.

What we keep and for how long

Each practice’s forms live in a database of their own on our server, never mixed with any other practice’s.
Your finished forms are saved to your own computer by ChiroUnchained Forms Saver, a free Chrome extension. It puts each finished form in a folder called ChiroUnchained Forms inside your Downloads folder, and we delete our copy 7 days after it is saved. You keep the record.
The extension confirms each saved form back to us before we count it as saved.
A form that is never saved to your computer is kept for 90 days from the day it was finished and then deleted. We e-mail you on day 60, day 75, day 85 and day 89 (the final notice: it is deleted at the end of the next day). The e-mails never name a patient.
Days are counted in your practice time zone. You set it on your Storage page; it starts as Eastern Time.
You can also download everything by hand after you sign in.
If you cancel, you can download everything right away. We delete nothing during the 30 days after your plan ends, so you have your full 30 days to save it all, even a form that reaches 90 days in that time. After those 30 days, we delete everything. To cancel, e-mail [email protected].

Price

$49 a month. No setup fee. We convert your own forms for you.
Month to month. No contract. To cancel, e-mail [email protected]; your forms keep working until the end of the month you paid for.
Spanish versions of your forms are optional: $10, one time.

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