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Mediprocity Secure Forms Estimate

Build Process:

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

**Revisions 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.

Estimate prepared for:

$

General pricing information

The starter level plan is $50/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

To approve this estimate if you are a new secure forms customer, please complete this order form:
Mediprocity - Secure Forms Order Form

To approve this estimate if you are an existing secure forms customer, please complete this order form:
Mediprocity - Secure Forms Existing Customer Order Form

If you require a rush order please also complete the following form:
Mediprocity - Rush Work Request (Order)