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digitize your patient intake forms.  TODAY FOR free.

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Your Brand

Branded digital patient intake form sent to your front desk for pediatric patient setup

Your terms and conditions 


Ability to automate patient intake material sending like follow up PDFs 



The ability for parents to complete the form online, on their phone, or on their tablet. 


The ability for waiting room completion via tablet or posting a custom link to your website


Insurance cards collection via  phone camera 

Mobile Phone

HIPAA Secure

Collect insurance information, medical history information, and personal information using a HIPAA compliant process. 

128-bit Advanced 

Encryption Standard (AES) ​


Simple patient intake, integrated with the next generation of parent communication.

With the free form, you have the option to turn on the TheraWe Connect platform at any time. This platform creates the opportunity for HIPAA compliant messaging, video parent training videos, and document storage. 


Improve patient outcomes and make the day to day lives better for therapy practitioners and caregivers.
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