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Privacy Patient Sign-In
Privacy Patient Sign-In

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Less than 3 packs Flat Shipping Rate $9.95
List Price: $65.00
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Unit Qty: 125
Unit: pack
Overall Dimensions: 8-1/2" W x 11"

Product Code: APSGN

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

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.

Instructions on how to use this form are printed on the back of each form.

  • 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.

    125 per pack - Privacy Patient Sign-In 27 positions for patients to fill personal information on removable strip.

    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.


    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.

Average Customer Review: 5 of 5 Total Reviews: 4 Write a review.

  3 of 3 people found the following review helpful:
Sign in Sheets July 13, 2017
Reviewer: Shawna York from New Castle, IN United States  
Like everyone else we watch supply cost. I happened to see the confidential sign in sheets and did the math - not only am I getting more signatures per sheet the cost is the same. Thank you!!

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  2 of 2 people found the following review helpful:
Sign in sheets July 13, 2017
Reviewer: Anonymous Person from Roanoke, AL United States  
We use these sign in sheets at all 4 locations. They are easy to use and keep us compliant.

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  0 of 0 people found the following review helpful:
Patient Privacy Sign in sheets August 1, 2016
Reviewer: Randy Watson from Valley Stram, NY United States  
Thank you,
They will come in handy.
It is professional to have these.

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  1 of 1 people found the following review helpful:
Great Deal June 14, 2016
Reviewer: Luna Beltran from Las Cruces, NM, United States  
I have found that these sign in sheets are the best. I cannot find any other sign in sheets with 27 lines, plus great quality and price! I received them right away after my order. I am glad I found this company.

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