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Submitting your Patient Registration and Health History prior to your appointment will save you valuable time and will allow the medical staff to give you more efficient service upon your arrival. The doctor will also have more time to evaluate your health history -- an important factor in your treatment.

To access the forms that are available for your doctor or health care provider, enter their office telephone number in the box on the right of your screen and then click 'Go to Forms'. This will take you to the list of forms where you can select the one you need.

When you complete a form, your submission of it will trigger an automatic notification to your doctor's office. They will then retrieve your information from their secure data base.
If you have a question about the information requested on any of the forms, please contact the doctor or health care provider to ask for clarification.

Secure online patient forms provided by SecureHIPAA.com are personalized and customized for all health care specialties. If you are a physician or other health care professional and would like to learn more about Secure Patient Forms and how you and your patients can benefit from this convenient service, Click here.

In accordance with the security requirements of The Health Insurance Portability and Accountability Act (HIPAA) that was enacted in August of 1996 and for the privacy of patients who use the online forms to submit their personal information and health history to their doctor, all data transferred to SecurePatientRegistration.com is secured with GeoTrust's SSL certificates that utilize the highest level of encryption or security possible.

This means you can rest assured that communications (e.g. patient information) between your browser and SecurePatientRegistration.com's web servers are private and secure when the SSL session is activated.

The Privacy Rule, as well as all the Administrative Simplification rules, apply to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA.


If you have questions about HIPAA or the Privacy Rule, you can go to http://www.hhs.gov

If you have questions about the Secure Patient Forms service, contact us or visit SecureHipaa.com.


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a Division of Secure Family Records



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