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Privacy Patient Sign-In
Privacy Patient Sign-In


 
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FREE SHIPPING! Buy 3 packs of this Item and get FREE SHIPPING!

Are you getting the best value for your Patient Sign-In Sheets?
  • With ACS you get 27 sign-in positions per sheet a total of 3,375 patient sign ins per pack.
  • If you use a 20 sign in sheet that's 875 more sign-ins per pack of 125 which = 7 packs of 20.
  • If you use a 23 sign in sheet that's 500 more sign-ins per pack of 125 which = 4 packs of 23.
  • If you use a 25 sign in sheet that's 250 more sign-ins per pack of 125 which = 2 packs of 25.
  • That's as many as 7 packs for free. More value for your Dollar.

First Time Buyers use this Code FTB-1995 to receive a 10% Discount on This Product, just type the code into the coupon box at check out and hit apply.
List Price: $198.00
Your Price: $128.00
You Save $70.00!
Unit Qty: 250
Unit: pack
Overall Dimensions: 8-1/2" W x 11"


Product Code: 14037

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Shipping Charge*: 		Order 1 - 2 Boxes or Packs Shipping Cost is $15.95
Order 3 or More Boxes or Packs Shipping is FREE!

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Description Freight, Returns & Sales Tax Policies
 
The ACS Patient Sign-In Sheets have 27 sign in positions! Color is Light Green.

Are you getting the best value for your Patient Sign-In Sheets?
  • With ACS you get 27 sign-in positions per sheet a total of 3,375 patient sign ins per pack.
  • If you use a 20 sign in sheet that's 875 more sign-ins per pack of 125 which = 7 packs of 20.
  • If you use a 23 sign in sheet that's 500 more sign-ins per pack of 125 which = 4 packs of 23.
  • If you use a 25 sign in sheet that's 250 more sign-ins per pack of 125 which = 2 packs of 25.
  • That's as many as 7 packs for free. More value for your Dollar.


Instructions on how to use this form are printed on the back of each form.
Colors & Features
  • How to Use This Form:
    • The 27 patient signature lines are a peel off adhesive label.
    • The Signature labels are numbered 1-27.
    • Patient signs in on the next available signature line
    • Their information is transferred through a carbonless sheet to a patient log sheet on the back of the form.
    • If you use the number to call the patient back to the exam room, instruct the patient after signing to remove the number from the left-hand column next to their signature line.
    • The receptionist then may peel off the precut signature line of patient information and apply it to the patient flow chart.
    • The patient information is not visible to other patients at this point. The security cover sheet (part 2 of the form) says "Please Use Next Line".
    • After completing an entire sheet or at the end of each day, separate the sheet by breaking the snap-set at the top and bottom perforations. Discard the top two sheets, you now have a complete, private list of all patients and their information. You can use these complete lists for reporting, daily audits or office records.
    Protect Your Patients' Privacy with ACS 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 Salmon, Lt. Blue, Lt Green.


  • Each form has 7 columns for each patient to fill out and 27
  • 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.

    Columns:
    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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Average Customer Review: Average Customer Review: 5 of 5 5 of 5 Total Reviews: 2 Write a review.

  2 of 2 people found the following review helpful:
 
5 of 5 HIPAA compliant sign in sheets August 1, 2019
Reviewer: Lee Birchansky from Cedar Rapids, IA United States  
The sheets are attractive, succinct and decently priced.

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  1 of 1 people found the following review helpful:
 
5 of 5 27 Sign In Postitions June 14, 2016
Reviewer: Cindy Pugh from Dallas, Texas  
We were using a similar form but it only had 20 sign in positions.  The ACS form has 27 and is a better price for same number of forms great value.

Was this review helpful to you?


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