Secure Medical Contact Forms

HIPAA compliant forms available on any website to feed leads directly into Influx MD

Quickly and easily create contact forms that can be used on any web property. With the form builder drag and drop interface, develop a simple contact form using standard name, email, phone and message fields in just a few seconds. 

Capture More Data

With a just a couple of additional steps, forms on pages protected with SSL can be used to capture additional demographic information for insurance verification or preauthorization.

Spam-Free Submissions

Use honeypot fields and reCaptcha for additional protection or simply rely on built in language checking and integrated anti-form spam protection

No Duplicates

Influx automatically checks all input to ensure duplicate leads are not added to your lead database. ¬†Messages from leads already in the system are placed directly into the lead’s record and if Influx MD is not sure about the lead it will suspend it for review by one of your team.

The look and Feel You Want

Forms can be formatted to match your clinic branding by your website developer using standard CSS or formatted using the form builder within Influx MD.  Either method provides seamless integration of the form into any web property with a minimum of effort.

More Patients With Less Effort See Pricing & Start Request a Demo