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Mediprocity Secure Forms Quote

Build Process:

  1. This quote covers the one-time fee for completing your secure form(s) submission.
  2. Build timelines typically require two weeks from the time we receive your completed order form (not the quote form).
  3. Rush orders (if possible) may incur an additional cost added to the quote.
  4. The quote includes a review process allowing for up to 3 hours of improvements at no cost.
  5. Requests for minor revisions (additions, edits, movements, or removals) must be made within 7 days of delivery and will be billed at $60/hour.
  6. Any bugs or errors (e.g., typos, layout mistakes, or functionality issues) caused by our development team will be fixed at no charge.

**Edits and adjustments include anything added, edited, moved or removed from the first draft of the web form and PDF draft.

***Bugs and errors include typos, layout mistakes, and functionality mistakes that were created in error by our development team during the form build process.

Quote prepared for:

$

To approve this estimate, please complete your Secure Forms order form:
https://secure-forms.mediprocity.com/forms/e0553902

If you require a rush order please also complete the following form:
https://secure-forms.mediprocity.com/forms/9179bcdd

General pricing information

The starter level plan is $30/month for 1-3 forms
The standard level plan is $60/month for 4-20 forms
The enterprise level plan is $100/month for 21+ forms
All forms prices include:

  • Design to match your company’s branding
  • Legally-binding documentation and “ink” signatures
  • Save & return later feature
  • Mobile and tablet-friendly
  • PDF, XML, Excel, CSV, SQL formats and more

Here are a few examples of our most popular forms (click to view):

Covid Vaccine Administration
Covid vaccine consent
Flu vaccine order form