New Dental Patient Form

Form Template for Hush Secure Forms

About Hush Secure Forms

Hush Secure Forms is our secure, digital alternative to old-fashioned paper forms. You can launch a beautiful, personalized web form for your business in minutes with our drag-and-drop form builder, template directory, and built-in secure web hosting.

New Dental Patient Form

A new dental patient form for your dental practice. You can send this form to your patients prior to their first appointment.

Try the form

Try Hush Secure Forms risk-free for 60 days

Ready to go digital? Sign up for any of our Hushmail for Healthcare plans today, and get a full refund if you cancel within 60 days. We'll even help you convert your paper forms to secure web forms. Not in Healthcare? See our plans for your industry here.

All plans include:
  • Business Associate Agreement (BAA)
  • Email archiving
  • Customer support by email and phone
  • 1 email account
  • Up to 2 secure web forms
  • 10 GB storage per email account
$ 9.99 /month
  • Up to 5 email accounts
  • Up to 5 secure web forms
  • 15 GB storage per email account
$ 19.99 /month
How many email accounts do you need?
How many web forms do you need?
  • 15 GB storage per email account
$ /month

Please contact us for custom pricing

Contact us

All prices displayed are in US dollars. Taxes may apply. Full refund if you cancel within 60 days.