Accessibility Tool

Forms Policy

Pricing and Guidelines

Free

For both Starter and Essentials, we will complete up to 5 changes for free to each of our smaller forms (Appointment Request, Feedback, Prescription Refill, Refer a Friend, Doctor Referral) as long as these changes still reflect the initial purpose of the form. Changes to these forms are included for both packages post implementation as the client is unable to make adjustments to their forms and keep them ADA accessible due to current limitations with the form builder.

Examples of the changes that will be made for free:

  • Renaming the form (Feedback Form to Contact Us form)
  • Adding a question for the patient to indicate a location for their appointment request
  • Adding a question for the patient to indicate a provider for their appointment request

Custom Form Add-on*

Available to either website package for making our stock patient registration forms custom. $20/month for the first custom form and $15/month for each additional custom form. These are products in CRM.

If the client is wishing to create a new form that is outside the purpose of any of our stock forms, then this will also be an instance for a custom form add-on. *This excludes the creation of HIPAA consent forms as they require physical signatures.

For example, the client wants us to build:

  • A contact lens order form for their website
  • Responsible Party Consent form
  • Contest form

Scenarios for Adding Form Package Product

  • Client discusses this option with their sales rep and it is included on the initial order form.
  • Client doesn’t purchase the form add-on during the initial order form, but during implementation (or once billing has started) decides they want to customize our standard registration form with an online version of their office form or they want to have us create a different custom form. The support team will request to have the Custom Form product added to the client’s account. Once added, work will begin.
  • Client’s site is live and they decide they want to customize our standard registration form with an online version of their office form or they want to have us create a different custom form. The support team will request to have the Custom Form product added to the client’s account. Once added, work will begin.

What does customization include?

  • Begin process with TeleVox Solutions Standard Forms
  • Modify the text fields on the form (add/edit/remove)
  • The client’s existing logo can be added but not edited
    • Must be supplied in a vector format: ai, jpg or eps
  • If Essentials package, the font/color will be styled to match the client’s custom design. There is no design consultation on this.

What is not customized?

  • We are unable to adjust the following:
    • Form layout on website
    • Form display on the associated PDF  
    • Print layout 

Contract Terms

  • The monthly add-on should continue the length of the client’s contract or for as long as their website is active with us, if that exceeds the contract terms. The client should never continue paying the Custom Forms add-on if their website is no longer active with us.
  • As long as the client is utilizing the custom forms that we built for them, then the client will pay the monthly add-on fee. The Monthly fee includes making additional customization updates to the forms (see above for what is included).
  • If the client decides to cancel the Custom Forms add-on, then we will remove the custom form from their website. If it was a custom patient registration form, they will then have the option to either use our standard registration form or send in a print-only pdf version of their office form.

Other Form Options

As a reminder clients can use our stock patient registration forms, unedited, free of charge. The add-ons are only for if they want the forms to be custom to have the same questions as the forms they have in their office. You can see the stock patient registration forms here:

Also, the client could send us their office forms and we could link them to their website for a download and print-only option for their patients. Here are a few examples of clients choosing to do that:

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