Good Faith Estimate
Use this secure Good Faith Estimate form to document expected costs of care —designed for sole practitioners at a single location. You complete the form, and the client receives a secure copy. Any patient information is encrypted and protected, helping you stay compliant with the No Surprises Act.
Form Template Preview
Submit this form to see what a completed submission looks like inside Hushmail:
Quick facts about this form
Who it's for:
- Sole practitioners
- Independent therapists or counselors
- Behavioral health providers
- Holistic care providers
Why use it:
- Provide clients with a clear breakdown of costs before care begins
- Stay compliant with the No Surprises Act using a secure, digital form
- Protect client information with automatic encryption and HIPAA-compliant handling
- Easily share a completed copy with clients for their records
Where to use it:
- After an intake call or consultation
- In a welcome packet for new clients
- As part of your onboarding workflow
Pairs well with:
Check back soon, as we’re continually adding more templates to our library.
If your client skips a required field, the form will prompt them to fill it out. No more chasing after clients to fill out missing info.
Your client’s submission will live in Hushmail, where you can keep all submissions secure and organized in folders.
You can also download a PDF of the submission if you want to file a separate copy elsewhere, like your EHR.
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You give us the form(s) you’re currently using in your practice.
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You get a dedicated Customer Care rep to oversee the service and answer questions.
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You end up with custom secure web forms that are easy for your clients to fill out.
