Request an Appointment (Dental)
Use this secure dental appointment request form to let new and existing patients request an appointment. With Hushmail’s secure forms, patient information is encrypted from the moment they reach out, so you can stay compliant and build trust from the start. Place it on your website, share it in online directories, or include it in your email signature.
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:
- Dentists
- Orthodontists
- Dental practices
- Dental office managers
Why use it:
- Protect patient privacy with automatic encryption and HIPAA compliance from the very first interaction
- Reduce phone volume and save admin time by routing appointment requests to one central Hushmail inbox
- Let patients request an appointment 24/7 without needing to call
- Provide a seamless digital experience
Where to use it:
- On your dental practice website (e.g., your contact page)
- In your email signature
- On your social media profiles
Pairs well with:
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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1.
You give us the form(s) you’re currently using in your practice.
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2.
You get a dedicated Customer Care rep to oversee the service and answer questions.
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3.
You end up with custom secure web forms that are easy for your clients to fill out.
