Request for transmission of protected health information by non-secure means
Form Template for Hush™ Secure Forms
This form allows your clients to use or not use non-secure communications and informs them of the risks.
Hushmail for Healthcare includes Encrypted Email and a Private Message Center with optional Secure Forms and Electronic Signatures. We'll include a signed Business Associate Agreement (BAA) and Email Archiving to help with your HIPAA compliance.
Your email address will end with @hushmail.com, @hush.com, @therapyemail.com, @counselingmail.com, @therapysecure.com or @counselingsecure.com.
Sign upYour email address will end with your own domain name @yourcompany.com. If you don't have a domain name, you can use a Hushmail subdomain @yourcompany.hush.com.
Sign upAll prices displayed are in US dollars. Taxes may apply. Full refund if you cancel within 60 days.
Hushmail for Small Business includes Encrypted Email, a Private Message Center, and an Email Archive, with optional Secure Forms and Electronic Signatures.
Your email address will end with @hushmail.com, @hush.com, @hushmail.me, @hush.ai or @mac.hush.com.
Sign upYour email address will end with your own domain name @yourcompany.com. If you don't have a domain name, you can use a Hushmail subdomain @yourcompany.hush.com.
Sign upAll prices displayed are in US dollars. Taxes may apply. Full refund if you cancel within 60 days.
Hushmail for Law includes Encrypted Email, a Private Message Center, and an Email Archive, with optional Secure Forms and Electronic Signatures. Plus, we'll sign an agreement with customers in the U.S., Canada and the U.K. to seek judicial protection for the account, if necessary, on the basis that the contents are privileged, providing extra protection for your communications.
Your email address will end with @hushmail.com, @hush.com, @hushmail.me, @hush.ai or @mac.hush.com.
Sign upYour email address will end with your own domain name @yourcompany.com. If you don't have a domain name, you can use a Hushmail subdomain @yourcompany.hush.com.
Sign upAll prices displayed are in US dollars. Taxes may apply. Full refund if you cancel within 60 days.
Hushmail for Personal Use includes Encrypted Email and a Private Message Center, with an email address ending in @hushmail.com, @hushmail.me, @hush.com, @hush.ai or @mac.hush.com. Custom email domains are not available on this plan.
The price displayed is in US dollars. Taxes may apply.
Published on October 21, 2024
Read this guide for answers to all your questions on using online forms in a small healthcare practice. Read more.