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Mediprocity Secure Forms Quote

Build Process:

  1. This quote 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 quote is generated).
  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 if you are a new secure forms customer, please complete this order form:
https://secure-forms.mediprocity.com/forms/e0553902

To approve this estimate if you are an existing secure forms customer, please complete this order form:
https://secure-forms.mediprocity.com/forms/7d57fa8f

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 $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

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

Covid Vaccine Administration
Covid vaccine consent
Flu vaccine order form