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Item Number: S-14541

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Make sure your healthcare facility or medical office is welcoming and accommodating with these Blue English/Spanish Confidential Patient Sign-In Forms from The Supplies Shops. Each of these HIPAA-compliant bilingual forms features room for 23 sign-ins. The forms also come with peel-off labels for each patient, which helps to ensure privacy when coming in for a visit. Whether you are signing in the patient in Spanish or English, they’ll feel more comfortable in your space when you take these extra steps for their comfort.

Once completed, you can remove the top sheet of the form to reveal a special backer with the complete log of the patient visits for the day. Each form features fields where patients can enter their name, arrival time, appointment time, appointment with, new patient check box and change of address, phone and insurance since the last visit.

  • Blue English/Spanish Confidential Patient Sign-In Forms
  • 8.5" x 11" forms
  • 23 peel-off labels included to keep patient sign-in logs confidential
  • Forms are bilingual (accommodating English and Spanish speaking patients)
  • 125 forms per pack
  • UPC Code: 8437114541
ASIN:B01MPXTYX5
Background Color:Blue
Brand:Tabbies
Feature 1:HIPPA Compliant (HIPPA Privacy Rule, Section 164.502)
Feature 2:Second Sheet is a complete record of all patients seen that day
Feature 3:Option to call patients by name or number
Feature 4:Carbonless
Feature 5:Patient Privacy Sign-In Sheet
Feature 6:A special back printing prevents writing from showing on the liner
Feature 7:Printing on the liner directs patients to sign the next line
Feature 8:125 Sheets / Pack
Feature 9:Bilingual Text: English and Spanish
Carbonless:Yes
Color:Blue
Condition:New
Currency:USD
Pre-Printed:Yes
Package Height:11 in
Package Weight:5.00 LB
Package Width:8-1/2 in
Material:Paper
Country of Origin:USA
Manufacturer Part Number:14541
Number of Items:125
Paper Size:Letter
Sheet Length:11 in
Sheet Size:8-1/2 x 11 in
Sheet Width:8-1/2 in
Ships in:1 to 3 Business Days (Plus time in transit)
Size:8-1/2 x 11 in
Text Color:Black
UPC:84371145416