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Healthcare · Automation Kit

Wellness intake that takes HIPAA seriously - chiro, massage, PT, with consent and photo release done right

Wellness practices (chiropractic, massage therapy, physical therapy, integrative health) often run intake on tools built for fitness studios - which means health history, treatment consent, and photo release end up on a non-BAA platform. The provider thinks 'we are not really healthcare,' but the moment a patient discloses a medical condition, an injury, or a medication on the form, the data is PHI and HIPAA applies.

What you'll receive
  • 6 Forms
  • 5 Emails
  • 5 Workflows
  • 5 Integrations
  • 4 Extras

Plus: Body-diagram tool for pain mapping (visual input, not text-only), Bilingual intake (English + Spanish), Mobile-first design tested on phones for in-clinic check-in …and more

Installed in your Jotform account.
You own everything. No monthly fees to me.

Kit contents

HIPAA Wellness & PHI Consent Kit

  1. 01Branching intake by visit type (chiro, massage, PT, integrative)form
  2. 02Health-history block with current conditions, surgeries, medications, allergiesform
  3. 03Pain-mapping section with body diagram for chiro and PT visitsform
  4. 04Treatment-specific consent (manual adjustment, deep-tissue, dry needling, modality risks)form
  5. 05Photo and video release for treatment documentation (optional, opt-in)form
  6. 06Emergency contact and primary care provider captureform
  7. 07Patient confirmation with first-visit expectations and what to wear - no PHI in bodyemail
  8. 08Provider notification - 'new submission for [provider name], click to view'email
  9. 09Treatment consent confirmation with link to signed copy in patient portalemail
  10. 10Pre-visit reminder 24 hours before appointmentemail
  11. 11Re-consent prompt at one-year mark for returning patientsemail
  12. 12Conditional branching by visit type so chiro patients do not get PT-only questionsworkflow
  13. 13Auto-flagging of contraindications (anticoagulants for deep-tissue, recent surgery for adjustment)workflow
  14. 14Routing to the named provider plus front desk - no broadcast notificationsworkflow
  15. 15Photo release retention separate from clinical record for cleaner deletion pathsworkflow
  16. 16Audit-trail note on every consent and treatment releaseworkflow
  17. 17Jotform HIPAA plan with signed BAA - requiredintegration
  18. 18Practice management software handoff via CSV export or webhookintegration
  19. 19PHI-safe storage for photo and video releases (Jotform retention or BAA Drive folder)integration
  20. 20Calendar handoff to Google Calendar, Calendly, or Mindbody (Mindbody for booking only - PHI stays in Jotform)integration
  21. 21Optional SMS reminder via BAA-covered SMS providerintegration
  22. 22Body-diagram tool for pain mapping (visual input, not text-only)extra
  23. 23Bilingual intake (English + Spanish)extra
  24. 24Mobile-first design tested on phones for in-clinic check-inextra
  25. 25Re-consent automation to comply with annual consent refresh expectationsextra
Installs in: JotformTested with: Jotform HIPAA, Practice management, Jotform retention or BAA Drive folderKit v1.0 · Updated Apr 2026

System diagram

01FORM02LOGIC03OUTPUT
The solution

How this kit actually works.

A Jotform-built wellness intake configured by a Jotform HIPAA expert. Branching health-history capture for chiro, massage, and PT visit types. Treatment-specific consent (manual adjustment, deep-tissue work, dry needling, modality-specific risk disclosure). Photo and video release for documentation when applicable. PHI-stripped notifications. Storage and retention configured to the regulatory standard the practice's licensing board expects, not the lighter standard of a fitness app.

What's included

Every piece, ready the day you buy it.

Forms

  • Branching intake by visit type (chiro, massage, PT, integrative)
  • Health-history block with current conditions, surgeries, medications, allergies
  • Pain-mapping section with body diagram for chiro and PT visits
  • Treatment-specific consent (manual adjustment, deep-tissue, dry needling, modality risks)
  • Photo and video release for treatment documentation (optional, opt-in)
  • Emergency contact and primary care provider capture

Emails

  • Patient confirmation with first-visit expectations and what to wear - no PHI in body
  • Provider notification - 'new submission for [provider name], click to view'
  • Treatment consent confirmation with link to signed copy in patient portal
  • Pre-visit reminder 24 hours before appointment
  • Re-consent prompt at one-year mark for returning patients

Workflows

  • Conditional branching by visit type so chiro patients do not get PT-only questions
  • Auto-flagging of contraindications (anticoagulants for deep-tissue, recent surgery for adjustment)
  • Routing to the named provider plus front desk - no broadcast notifications
  • Photo release retention separate from clinical record for cleaner deletion paths
  • Audit-trail note on every consent and treatment release

Integrations

  • Jotform HIPAA plan with signed BAA - required
  • Practice management software handoff via CSV export or webhook
  • PHI-safe storage for photo and video releases (Jotform retention or BAA Drive folder)
  • Calendar handoff to Google Calendar, Calendly, or Mindbody (Mindbody for booking only - PHI stays in Jotform)
  • Optional SMS reminder via BAA-covered SMS provider

Extras

  • Body-diagram tool for pain mapping (visual input, not text-only)
  • Bilingual intake (English + Spanish)
  • Mobile-first design tested on phones for in-clinic check-in
  • Re-consent automation to comply with annual consent refresh expectations
Pricing

Pick the fit. Upgrade later if you need to.

Base Kit

Ready to run, self-setup

$149

  • Branching intake form, treatment consent template, photo release form
  • HIPAA setup notes specific to wellness practices
  • 30-minute video walkthrough
  • PHI-stripped notification configuration
  • 14-day email support
Book a call
Most popular

Pro Setup

Kit + setup call + customization

$279

  • Everything in Base
  • 60-minute setup call with a Jotform HIPAA expert
  • BAA chain audit (Jotform + practice management + storage + scheduling)
  • Treatment-specific consent variants tailored to your modalities
  • Body-diagram pain-mapping tool configured
  • 30-day email support
Book a call

Done-For-You

Full implementation by me

$599

  • Everything in Pro
  • Full implementation in your HIPAA Jotform account
  • Provider and front-desk training session
  • Practice management software integration configured
  • Bilingual variant (English + Spanish) configured
  • 90-day priority support and one post-launch tuning round
Book a call
Frequently asked

The questions I get before someone buys.

  • Do wellness practices actually need HIPAA-compliant intake?

    If you collect health history, medications, injuries, or treatment consent - yes. The 'we are not really healthcare' framing fails the moment a patient discloses a condition or medication on the form. Wellness practices that bill insurance are unambiguously HIPAA-covered. Cash-pay-only wellness practices are in a softer zone but still subject to state privacy law and licensing-board expectations, which often look a lot like HIPAA in practice.

  • How does this differ from the general patient-intake kit?

    Wellness intake branches by modality (chiro vs massage vs PT), includes a body-diagram pain-mapping tool, and has treatment-specific consent variants (manual adjustment risks, deep-tissue contraindications, dry-needling consent) that the general patient-intake kit does not. Photo and video release for documentation is also wellness-specific.

  • Does this work with Mindbody, Vagaro, Jane App, or my practice management tool?

    Yes for booking handoff. The pattern is: PHI lives in Jotform, scheduling lives in Mindbody/Vagaro/Jane App, and only the booking confirmation flows between them - never the clinical detail. For Jane App specifically (which has a HIPAA tier and BAA available), the kit can route structured clinical data via CSV. For Mindbody and Vagaro, PHI stays in Jotform and only appointment metadata syncs.

  • What about the photo release for treatment documentation?

    Photo and video release is opt-in, captured as a separate dated record, and retained independently of the clinical record. This makes it cleaner to delete on patient request without touching the underlying treatment notes. The release covers internal documentation only by default; marketing use requires an explicit additional opt-in.

  • How do you handle contraindications and risk disclosure?

    The intake auto-flags common contraindications - anticoagulants before deep-tissue, recent surgery before manual adjustment, certain medications before dry needling. The provider sees the flag in the authenticated submission view before the session, not in an email body. The treatment consent itself includes modality-specific risk language reviewed by your licensing board's standard.

  • How is this different from hiring a generic Jotform freelancer?

    A generic freelancer will build the form on a non-HIPAA Jotform plan because the practice 'is not really healthcare'. A Jotform HIPAA expert recognizes that the moment health history is on the form, the data is PHI, and the BAA is required. The expert also bakes in modality-specific consent, pain-mapping, and contraindication flagging that a generalist will not know to ask about.

  • How do I hire you for a wellness practice setup?

    Pick the Done-For-You tier or book a 20-minute scoping call from the contact page. We confirm modalities, practice management tool, insurance billing status, and licensing-board expectations, then send a fixed-price proposal within 48 hours. Most wellness practices ship in about one to two weeks.

Not sure if this is the right kit?

Free 20-minute call. Tell me what you're trying to do - I'll tell you if a kit fits, or if you need something custom, or if you shouldn't pay me at all.