AlpineForm Registration

The following form will create your account. You will then be directed to Stripe to enter payment info. And lastly, you’ll end up on your Account page to upload your patient forms for electronic conversion.

AlpineForm – Client Info
cancel1 check1 Eight characters minimum cancel1 check1 One lowercase letter cancel1 check1 One uppercase letter cancel1 check1 One number cancel1 check1 One special character
We use your Business ID to create a unique URL for your forms. For example, say your business is called Dunder Mifflin. You might want to use “dundermifflin” for your ID. Your forms will be at alpineform.com/dundermifflin.

Your Profile

Your direct email address, please.
Your direct number, please.
Business Address (Office Location)
Business Address (Office Location)
City
State/Province
Zip/Postal
Please include http:// or https://

Business Associate Agreement

Please read the following contract and sign below. A PDF copy will be emailed to you for your records.

Type your signature here.
BAA Confirmation

Business Details

https://
If you’d like to use a custom domain for the public page that indexes your forms, please enter it here. This must be different than your Business Website/URL, but may be a subdomain, e.g. forms.yourbusiness.com. If blank, the page will be at alpineform.com/yourbusiness.
This is where we will send a PDF each time one of your forms is filled out. IMPORTANT: This address will receive electronic protected health information. It is your responsibility to ensure that it is correct and that your email provider is compliant with HIPAA Rules.

Maximum file size: 10MB

You’ll be able to add this later. We use your logo for branding your digital forms. It will be displayed on a white background.

Maximum file size: 10MB

Optional: if you’d like your public page to have a dark background (example), please add a light version of your logo so it looks good.

Admin Only

Maximum file size: 268.44MB