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  Bilingual Privacy Patient Sign-In
Bilingual Privacy Patient Sign-In

Buy 3 packs of this Item and get FREE SHIPPING!
Less than 3 packs Flat Shipping Rate $9.95
List Price: $65.00
Your Price: $39.50
You save $25.50!
Unit Qty: 125
Unit: pack
Overall Dimensions: 8-1/2" W x 11"

Product Code: W-PS-BL-1

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Description Freight, Returns & Sales Tax Policies
The New ACS Bilingual Patient Sign-In Sheets now have 27 sign in positions and have a New Look!

Are you getting the best value for your Patient Sign-In Sheets?

Most sign-in sheets have 20, 23 or 25 sign-in positions.
With ACS you get 27 sign-in positions per sheet which equals 250 more sign-ins per pack of 125.
  • 20 positions / 125 sheet pack = 2,500 sign-ins
  • 23 positions 125 sheet pack = 2,875 sign-ins
  • 25 positions / 125 sheet pack = 3,125 sign-ins
  • 27 positions / ACS Sign-in 125 sheet pack = 3,375 sign-ins.
More value for your Dollar.

  • 25 per pack - Privacy Patient Sign-In 27 positions for Patients to fill personal information on removable strip.

    Protect Your Spanish speaking and English speaking Patients' Privacy with the
    ACS Bilingual Sign-in Sheets for less than $.011 per patient sign in.

    Patients fill personal information on removable strip. Carbon sheet transfers information to the back so other patients do not see previous patient’s information Meets HIPAA Requirements
    Available in Lt. Blue

    Each form has 7 columns for each patient to fill out and 25 patient positions to fill out on a numbered slip, when finished filling out they remove the slip and hand to the receptionist leaving a blank space on sign in sheet front page. The information is transferred via carbon paper to a master log. When patient removes the slip, that space is blank and the patient information is protected behind the carbon paper, available only for office use.

    1) Number
    2) Patient Name,
    3) Appointment time,
    4) Arrival Time
    5) Appointment With
    6) New Patient check column
    7) Any changes to patient information since last visit.

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