HIPAA-Compliant Online Appointment Requests

Now offering a customizable and easy-to-use appointment request form

Allow your website visitors to request appointments outside of visiting hours!

Call 888.950.0808, for pricing!

This form allows you to make the most of the opportunity you have to convert a website visitor to a patient. The form provides your site visitors - your prospective patients- a means for asking to be contacted for an appointment at the time they are viewing your website, which is often outside normal business hours. The forms color scheme is customizable and there is a space for a practice logo for seamless integration with your website. An e-mail notifies office staff when a request has been received. Office staff then contact the patient knowing in advance much of the information needed to set up the first appointment. There is no learning curve for use so the form can be up and working for your practice in a day!

Sample form

“We have been very pleased with the appointment request form. In our “high tech” world patients appreciate that they can find information about our practice and request an appointment on THEIR time knowing we will follow up when it is convenient for them. 90% of patients who submit an appointment request schedule an appointment and 85% of those present in the office at the scheduled time. It is virtually no effort on our part and a win-win for all parties. It is just another way we generate revenue for the practice.” 

Kathy, Practice Manager
Jacob Zamstein, MD, LLC