Form builder
The canvas is the form. Place one, two, or three fields on a line, preview a draft, and add your logo. Save and duplicate templates.
Features
Everything a specialist office needs to receive a referral, and nothing that belongs in a charting system.
Starter templates
Periodontics with NovaPerio-style categories, endodontics, oral surgery, orthodontics, and a general referral.
Versioned publishing
The live link stays the same. Each publish keeps a copy of the questions, choices, and branding used that day.
Guest submission
No account for referring offices. Double-clicks do not create two referrals. A receipt is issued only after the referral is saved.
Paper
Blank form, Print without submitting, and Submit and print. Unsent printouts say Not submitted online.
Inbox
Status, assignment, and private notes. A badge shows how many referrals are still New. Billing-only staff cannot open them.
Files
PDF, JPG, and PNG, checked by file contents. A safety scan runs before anyone can download a file.
Notifications
A short email says a referral is waiting. Patient names stay out of the email, the web address, and the card processor.