You will get HIPAA compliant Intake Forms for Telemedicine Companies
Top Rated
Top Rated
Project details
I offer the creation of all-inclusive, HIPAA-compliant intake forms using Jotforms GOLD plan (client subscription required). This gig includes pre-checkout and post-checkout intake forms, contact us forms, and sales agent intake forms, all crafted with advanced conditional logic, consent fields, and branded design.
I will implement a detailed logical workflow based on your telehealth company's operations and doctor networks specific requirements, ensuring a seamless and secure data intake process. Whether you are a clinic, wellness provider, or telemedicine platform, these forms will streamline patient onboarding, enhance compliance, and deliver a professional user experience.
I will implement a detailed logical workflow based on your telehealth company's operations and doctor networks specific requirements, ensuring a seamless and secure data intake process. Whether you are a clinic, wellness provider, or telemedicine platform, these forms will streamline patient onboarding, enhance compliance, and deliver a professional user experience.
Programming Languages
HTML & CSSCoding Expertise
Cross Browser & Device Compatibility, Performance Optimization, DesignWhat's included
| Service Tiers |
Starter
$400
|
Standard
$600
|
Advanced
$800
|
|---|---|---|---|
| Delivery Time | 7 days | 10 days | 14 days |
Number of Revisions | 4 | Unlimited | Unlimited |
Number of Pages | 1 | 2 | 4 |
Design Customization | |||
Content Upload | |||
Responsive Design | |||
Source Code |
Optional add-ons
You can add these on the next page.
Fast Delivery
+$200 - $400
Additional Page
(+ 2 Days)
+$150
11 reviews
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BT
Bamba T.
Jan 8, 2026
Tally.so Form Logic and Calculations
SE
Sal E.
Jul 11, 2025
Jotforms expert in building out forms
Charmin has been absolute pleasure to work with. Available whenever you need him. Quality of work is amazing and above what he puts on his profile. We hired him to help with Jotforms and he's been able to develop a lot more than just our Jotforms. Like very technical coding in our backend systems. One of the best hires I've had from Upwork in over 8 years being on the platform and hiring hundreds of people.
EA
Eriane A.
Jun 25, 2025
Embedded form linked to Jotform
SW
Shlomo W.
May 30, 2025
Tally.so Conditional Logic and Form Calculations
I had a great experience working with Charmin, he went above and beyond on this project and I look forward to working with him again.
CP
Chloe P.
May 8, 2025
Set up newsletter with quiz lead magnet
Charmin was available, patient and honest and completed the job to satisfaction
About Charmin
Jotform | Typeform | Cognito Forms | Tally Forms | HIPAA Forms
100%
Job Success
Owen Sound, Canada - 5:01 pm local time
As a seasoned professional with over 7 years of experience in customer service, management, and technical problem-solving, I am eager to bring my expertise to freelance opportunities. I have successfully held roles such as Senior Advisor in call centers, Customer Service Manager, and retail positions, where I developed strong leadership, operational efficiency, and exceptional customer satisfaction skills.
Certified with a Canadian Mutual Funds Course license, I am committed to continuous professional growth. Currently, I am enhancing my capabilities through certifications in Project Management (CAPM) from the Project Management Institute and Google Project Management, equipping me to excel in project planning, execution, and team collaboration.
I specialize in combining innovative thinking with analytical expertise to deliver tailored solutions. Whether you're looking for project management support, customer service strategy, or technical problem-solving, I bring dedication, adaptability, and results-driven focus to every project. Let's collaborate to achieve your goals!
Steps for completing your project
After purchasing the project, send requirements so Charmin can start the project.
Delivery time starts when Charmin receives requirements from you.
Charmin works on your project following the steps below.
Revisions may occur after the delivery date.
Analyze your Doctor Network's Requirements