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Legacy Custom Forms

This article covers the steps to build a Custom Form along with a video tutorial of the process. 

  • Create a Custom Form

    1. Navigate to Settings 
    2. Click Patient Forms 
    3. Click "Add a Form"Snag_6c596512.png
    4. Name your Form
    5. Choose Form Properties.
      For more information please see How to Choose Form Properties.
    6. Click "Save & Next"Snag_6c98fa1c.png
    7. Drag & Drop question type into the form and format your questions as needed. Snag_6c5f3951.png

    Note: A signature is included by default for all RevenueWell forms, dragging in a "Signature"  will indicate that the patient needs to sign more than once. 

  • Video Tutorial

  • FAQs

    How can I add HIPPA consent to a custom form?

    The last drag-and-drop option when creating a custom form is "HIPPA"

    By dragging the HIPAA option to the form, you will see that you have  3 options to choose from:  

    • Notice of Privacy Practices (Default selection)
    • HIPAA Consent
    • HIPAA Authorization


    All HIPAA options can be added to a document; however, the HIPAA options can only be used once per form. Keep the following rules in mind to help ease the creation of your HIPAA form:

    • One option can be chosen per checkbox
      HIPAA elements will require a check to complete a form.
    • When an option has been selected it will no longer be available to select again, which means it will be grayed out on other HIPAA elements.
    • When all 3 options have been selected for use in the form, another element can no longer be added.
    • When the "Question" field has not been filled in, there will be "suggestive text" filling in the text box until you begin to type your question.
    How do I create a custom form with multiple signature blocks? You will use the same "drag and drop" action for placing the signature box where you would like, within the form layout: 

    A few helpful descriptions with the signature box are as follows:

    • "Signature Of": Describes whose signature is needed. For Example: the Doctor's Signature/Patient's Signature/Responsible Party's Signature
    • "Description": Statement describing to the patient what they are signing
    • "Relationship To The Patient": These signer options are the drop down options visible to the patient for the signature
    • "Name If Not The Patient": A box to fill in the name of the signer.