Healthcare admin
New patient registration forms for clinics
Collect registration details, insurance cards and referral letters before the first appointment. For admin paperwork. Free to start.
For administrative paperwork, not clinical records.
Insurance card
Processed- Insurer
- Bluebell Health
- Member ID
- •••• 9036
- Plan
- PPO Silver
- Valid until
- Mar 31, 2027
AI-generated — verify against the original document
What you see for each submission
New patients complete registration online before their visit and upload their insurance card, photo ID and referral letter. AI pulls out insurer, plan and member details, keeping only the last four characters of ID numbers, so the front desk has everything ready at check-in.
- Insurer, plan and validity dates from insurance cards
- Referring practice and dates pulled from referral letters
- Name mismatches between a card and the form pointed out
Forms you can build
- New-patient registration
- Referrals
- Insurance details
Documents people upload
- Insurance cards
- Referral letters
- Photo ID
PDF, PNG, JPG or WebP.
How it works
- 1
Describe the form
Write what you need in plain English. AI drafts the sections, questions and upload fields as a structured form.
- 2
Edit and publish
Adjust anything in the editor, preview it on desktop and mobile, then publish to get a shareable link.
- 3
Review with assistance
Answers and documents arrive in your dashboard. AI extracts key details and flags what's missing.
AI assists. People decide.
Built for fair, careful review of people's applications.
- The AI never approves, rejects, scores or ranks anyone. It extracts and summarizes so you can review faster.
- It is instructed not to comment on protected characteristics such as race, religion, disability, age or family status.
- Every AI result is labeled and shown next to the original document, because AI can make mistakes.
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Free to start. No credit card.