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HIPAA Compliant Sign-In Sheets, Burgundy, 125 Count

  • Keep your front desk secure while controlling patient flow using our carbonless, 3-part patient sign-in forms, featuring a top sheet of peel-away labels, a security cover sheet in the middle, and a tear-away transfer sheet on the bottom.
  • Maintain HIPAA compliance and keep patient information confidential thanks to the security sheet attached below the sign-in sheet, so each patient can sign in safely without seeing information of other patients.
  • Conceal patient information from public view while retaining a daily log of your sign-in sheet for reference or audit purposes. Sign-in information is instantly imprinted onto the transfer sheet below yet remains securely blocked from the view of others.
  • Each line on the sign-in sheet peels off to become a self-adhesive label sticker, which can be the applied directly to the patient folder, form, or other office records.
  • Save money on your medical office supplies while retaining impeccable day-to-day records of patient arrivals and updates to their personal information. With 25 lines per sheet in this 125 pack of forms, you can serve up to 3,125 patient visits using this bulk pack of sign-in sheets.


For those in the medical or healthcare fields, your patients’ and clients’ trust is important. Our HIPAA-compliant sign-in forms are designed to conceal private patient information as effectively and economically as possible. Each line on the form can be peeled away by staff members as patients sign in for their appointments.The peel-away labels have a sticky backing that can be reapplied to your patients’ medical charts or other office forms.

Information handwritten on the top layer of labels is transferred onto a log sheet below while being concealed by a security sheet that reads ‘Please Use Next Line’ when the label above is peeled away. The log sheet with the transferred information can be accessed by tearing away the perforated bottom edge, then retained as a daily log for audits or other reference needs. 

Each sheet is intended for daily use and includes boxes for marking:

  • Patient name
  • Appointment time and arrival time
  • Name of the professional to be seen
  • Whether or not the patient is a new patient
  • If there have been changes to the patient’s phone, address, or insurance

    We stand behind our products completely. We understand that buying products online can sometimes be difficult because you cannot physically see what you are buying; however, if our product is not exactly what you are looking for or does not meet your expectations, then we welcome you to send them back anytime for a 100% refund. Click here for more information regarding refunds or returns >

    Key Features:

    • 3-part patient sign-in form
    • Peel-away adhesive labels
    • Carbonless
    • HIPAA compliant
    • Burgundy
    • 125 forms

    Product Details:

    • Brand: Blue Summit Supplies
    • Part #: BSS-92588-364
    • SKU: BSS-92588-364
    • Barcode: X0029HH4C5
    • Package dimensions: 11.5 x 8.5 x 1.8 inches
    • Package weight: 2 lb