SECURE WEBSITE FORMS for MEDICAL PRACTICES

Learn from your leads and reduce your team's data input time with contact, registration, survey, quiz and profile forms protected by HIPAA compliant servers.

With its powerful drag and drop form builder, Influx MD allows system administrators to develop forms to collect lead information for any situation. No coding or technical expertise is required.

Placing a single short snippet of code generated by the form-builder on any online property, your forms are instantly available to leads. Modification to any form automatically updates wherever the form appears without needing a web developer to make the changes.

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Multiple Form-Types

Make it easier for leads and patients to provide information to you with a secure lead profile form on your website.

Contact Forms: Generate simple contact forms in less than a minute using the form builder. With preconfigured fields for, name, email, phone, and more you can drag them onto the form and publish it immediately.

Registration Forms: Improve event registration with online forms linked directly to your event schedule. Registration forms are connected directly to events within the event scheduler making it easy for your leads to show interest and enroll in a live seminar or education program.

Profile Forms: Need more information than a standard contact form? Profile forms contain 90+ demographic, insurance, employer, and guarantor related fields to get you started on the verification or preauthorization process. You can gather information right from your website or use the 3 stage security features of your HIPAA compliant Clinic Link™ portal

Surveys and Quizzes: Use the self-grading online quiz builder to create any length evaluation and attach it directly to your educational materials. Use custom surveys to build a comprehensive profile about leads to help you better meet their needs.


Adjustable Look and Feel

Quickly and easily format your forms to match your website.

Globally set the look of your online forms, or format them individually to match the page where they appear.

Have your web developer adjust form layout with local CSS or use CSS within Influx to override local settings and control your form without using developer resources.

Easily adjust form field layout from a single or double column for contact forms to a single line for newsletter signup forms.

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Validation and Tracking Built-In

Protect Your Systems and Your Data.

Automatically block spam and malware without Captcha input fields annoying your leads. Let Influx correct omissions and stop duplicate entries without any effort on your part. Influx forms store referral information for your campaign tracking and use submission redirects to send leads to whatever thank-you page you wish.