onlinepatientforms.com Open in urlscan Pro
173.231.216.25  Public Scan

Form analysis
3 forms found in the DOM

POST #wysija

<form id="form-wysija-shortcode674e550a6f148-1" method="post" action="#wysija" class="widget_wysija shortcode_wysija">
  <p class="wysija-paragraph">
    <input type="text" name="wysija[user][email]" class="wysija-input validate[required,custom[email]]" title="Enter a valid email address" placeholder="Enter a valid email address" value="">
    <span class="abs-req">
      <input type="text" name="wysija[user][abs][email]" class="wysija-input validated[abs][email]" value="">
    </span>
  </p>
  <input class="wysija-submit wysija-submit-field" type="submit" value="Tell Me More">
  <input type="hidden" name="form_id" value="1">
  <input type="hidden" name="action" value="save">
  <input type="hidden" name="controller" value="subscribers">
  <input type="hidden" value="1" name="wysija-page">
  <input type="hidden" name="wysija[user_list][list_ids]" value="1">
</form>

POST /#wpcf7-f5-o1

<form action="/#wpcf7-f5-o1" method="post" class="wpcf7-form" enctype="multipart/form-data" novalidate="novalidate">
  <div style="display: none;">
    <input type="hidden" name="_wpcf7" value="5">
    <input type="hidden" name="_wpcf7_version" value="5.1.4">
    <input type="hidden" name="_wpcf7_locale" value="en_US">
    <input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f5-o1">
    <input type="hidden" name="_wpcf7_container_post" value="0">
  </div>
  <div class="one-half"><span class="wpcf7-form-control-wrap Practice_Name"><input type="text" name="Practice_Name" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Practice Name"></span></div>
  <div class="one-half last"><span class="wpcf7-form-control-wrap Phone"><input type="text" name="Phone" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Phone"></span></div>
  <div class="one-half "><span class="wpcf7-form-control-wrap Your_Name"><input type="text" name="Your_Name" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Your Name"></span></div>
  <div class="one-half last"><span class="wpcf7-form-control-wrap Website"><input type="text" name="Website" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Website: (optional)"></span></div>
  <div class="one-half "><span class="wpcf7-form-control-wrap E_mail"><input type="email" name="E_mail" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" aria-required="true"
        aria-invalid="false" placeholder="Email:"></span></div>
  <div class="one-half last"> <span class="wpcf7-form-control-wrap file-600"><input type="file" name="file-600" size="40" class="wpcf7-form-control wpcf7-file" accept=".pdf,.doc,.docx,.jpg,.jpeg,.png,.tif" aria-invalid="false"></span></div>
  <div class="full-width"><input type="submit" value="Send" class="wpcf7-form-control wpcf7-submit"><span class="ajax-loader"></span>
    <div class="fusion-slider-loading"></div>
  </div>
  <div class="wpcf7-response-output wpcf7-display-none"></div>
</form>

POST #wysija

<form id="form-wysija-3" method="post" action="#wysija" class="widget_wysija">
  <p class="wysija-paragraph">
    <input type="text" name="wysija[user][email]" class="wysija-input validate[required,custom[email]]" title="Enter a valid email address" placeholder="Enter a valid email address" value="">
    <span class="abs-req">
      <input type="text" name="wysija[user][abs][email]" class="wysija-input validated[abs][email]" value="">
    </span>
  </p>
  <input class="wysija-submit wysija-submit-field" type="submit" value="Tell Me More">
  <input type="hidden" name="form_id" value="1">
  <input type="hidden" name="action" value="save">
  <input type="hidden" name="controller" value="subscribers">
  <input type="hidden" value="1" name="wysija-page">
  <input type="hidden" name="wysija[user_list][list_ids]" value="1">
</form>

Text Content

1-844-515-2345 Office Login|

 * HOW IT WORKS
   * 1-MINUTE VIDEO OVERVIEWS
   * SETUP AND USAGE EXPLAINED
 * REQUEST A DEMO
 * PLANS & PRICING
 * FAQ
 * INTEGRATION
   * API Access
   * Import & Export
 * HIPAA & SECURITY
 * ABOUT US


 * HOW IT WORKS
   * 1-MINUTE VIDEO OVERVIEWS
   * SETUP AND USAGE EXPLAINED
 * REQUEST A DEMO
 * PLANS & PRICING
 * FAQ
 * INTEGRATION
   * API Access
   * Import & Export
 * HIPAA & SECURITY
 * ABOUT US


   
 * A great first impression
   begins with Painless Forms
   
 * Secure online forms
   cut costs and save time
   
 * Your forms at their
   fingertips
   
   
   
 * Value patient's time to
   build your brand
   
 * Forms done pre-appointment create
   less stress at the front desk
   
 * Happier patients
   add value to your practice






Video Player
https://www.alphainternet.com/_videos/home_page_20170901.mp4

00:00
00:00
00:48
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GREAT FOR DENTISTS, CHIROPRACTORS, OR ANY OFFICE WITH PAPER FORMS.


VIEW 1-MINUTE VIDEOS TO SEE HOW WE HELP OFFICES JUST LIKE YOURS!

1-minute Video Overviews




ENTER YOUR E-MAIL ADDRESS TO LOCK IN YOUR 60-DAY WORRY FREE GUARANTEE.

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We will contact you at  your e-mail address below










PAINLESS FORMS WILL BUILD YOUR BRAND
AND GROW YOUR PRACTICE.



See Why Offices and Patients Love Painless Forms Below!






WHAT OUR CLIENTS SAY




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Mark Ismer, Customer Experience Manager at InPost

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> aliqua.

Brian, Clinica Health



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Anna, Business Manager at Zaricon







THE ONLINE PATIENT FORMS ADVANTAGE



   
 * LEVERAGE
   PATIENT FORMS
   
   
   
   Patients get a great first impression of your office and easily fill out your
   exact appointment forms at home or work using their own phone, tablet or
   computer. Optionally provide tablets for your waiting room.
   TIME SAVING
   BRAND BUILDING
   Happier patients, better systems, and a great first impression help to build
   a better brand.
   PRODUCTIVITY ENHANCING
   Offices get secure and HIPAA compliant tools to monitor progress and
   pre-verify insurance while cutting costs, reducing paperwork, streamlining
   processes and increasing productivity.
   
 * LEVERAGE
   PATIENT FORMS
   
   
   
   Patients get a great first impression of your office and easily fill out your
   exact appointment forms at home or work using their own phone, tablet or
   computer. Optionally provide tablets for your waiting room.
   TIME SAVING
   BRAND BUILDING
   Happier patients, better systems, and a great first impression help to build
   a better brand. Optional simple follow-up surveys help prevent bad online
   reviews and build good ones.
   PRODUCTIVITY ENHANCING
   Offices get secure and HIPPA compliant tools to monitor progress and
   pre-verify insurance while cutting costs, reducing paperwork, streamlining
   processes and increasing productivity.





OFFICES LOVE



 * Using their existing forms that are 100% legible with all required questions
   answered
 * Being seen as organized and high-tech by patients
 * Encountering happier patients that appreciate filling out their forms at home
   or work
 * Having more face time with new patients to build a great first impression
 * Handling insurance problems BEFORE patients arrive
 * Having technology that ensures all required questions have been answered
 * Experiencing fewer no-shows with form reminders




PATIENTS LOVE



 * Using less paper and being more eco-friendly
 * Having less stress as their forms finished before they walk in your door
 * Using their own phone, tablet or computer to fill out their forms at their
   pace
 * Having confidence that all forms are correctly and completely filled out
 * Using modern technology that is secure, well-designed, and familiar
 * Using an office that values their time
 * Having a warmer office experince that doesn’t start with a clipboard of paper
   and a time crunch
 * Responding only one time to common questions like name, address and date of
   birth where responses can pre-fill on other forms





$25 AMAZON GIFT CARD


YOU GET A GIFT CARD WHEN YOU TAKE A LIVE DEMO TO SEE HOW WE CAN REVOLUTIONIZE
YOUR FORMS

REQUEST DEMO




REQUEST YOUR DEMO




QUICK LINKS

 * HOW IT WORKS
 * REQUEST A DEMO
 * PLANS & PRICING
 * FAQ
 * Integration
 * HIPAA & SECURITY
 * About Us



60-DAY WORRY-FREE GUARANTEE





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