Secure Contact Form
Use this contact form to collect enquiries from anyone. It’s an amazing way to protect your clients’ information before they even become a client — because the personal information they share may be sensitive without them even knowing it.
Place it on your website and publish your link in online directories. Include a link in your email signature, and more.
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:
- Chiropractors
- Solopreneurs
- Legal practices
- Businesses
- Behavioral health practitioners
- Healthcare practitioners
- Physical therapists
- Massage therapists
Why use it:
- You’ll receive the completed form right in your Hushmail inbox — where you can reply and start a dialogue with your prospective client.
- Build trust with clients right from the start. (The form tells them the details they submit are encrypted and secure.)
- Keep a prospective client’s personal details secure — with automatic encryption.
Where to use it:
- On your website (e.g., your Contact Page)
- As a link in your Psychology Today profile
- As a link in your email signature
- As a link in your social media profile
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.
