TruForm

Consent Form Questionnaire

TruForm Consent Questionnaire

Step 1 of 5

TruForm Consent Questionnaire
Practice Name*
Doctor Name(s)*
Please include ALL doctors on this account.
Date (mm/dd/yyyy)
Website URL*
example: www.mywebsite.com or www.pbhs.com
Contact E-mail Address*
If PBHS Support has any questions, we would like to use this e-mail to communicate.

If you already have a TruForm v6 Account with us, we can add these TruForm Consent forms to your existing account. If these are your first TruForms on our TruForm v6 system, we will need to create an account for you.
Do you have an existing TruForm v6 Account? I.e., do you sign in to MySecurePractice.com in order to view your registration or referral TruForm submissions?*
Do you have an existing TruForm v6 Account?
Multiple office locations - please specify how many locations you have in your practice.*
Please enter a number from 1 to 50.
As a reminder, monthly hosting is $55 per month per office.
Multiple office locations - please specify the names of each office.
Would you like to set up unique forms for each office?*
- Yes, I want each office to receive their submissions separately
- No, I want to receive all of the submissions in one shared pool
Please let us know if your practice would like each office to receive their own form submissions separately. Please note that if you do, there may be a one-time $150 setup fee per additional office location, and each office will have its own separate TruForm link.
Please select your practice specialty:*
If other, please specify your practice specialty:

TruForm Setup Questions

3. Your TruForm user account

You will need to log into your TruForm account in order to invite patients to fill out your Consent forms. You will enter any necessary information (such as alternative treatment options, side-effects, etc) if any, then invite the patient to complete the form.

When the patient submits their forms, you will then login to our secure server to view the submitted forms, using your email address and a password you will set.
Email address to use for your truForm user account*
Additional Office Emails
If you have more than one office and would like to receive your submissions separately, we will need at least one unique email for each office. Please list them above.
Do you have a logo you would like on your forms?
- Yes
- No
Our newest TruForm system allows us to use your logo in the header of your TruForm. An example can be viewed here: View Example Here!
If yes, please upload your logo here
We will need your logo in a .bmp, or .png format. Please provide a version of your logo that has transparency for best results.
Accepted file types: bmp, png.

You've almost completed your TruForm setup questionnaire, PLEASE SCROLL DOWN TO SUBMIT!

PBHS Support will use the contact information provided to reach out to you with any questions or if any further information is needed.

Additional truForm information

Please note: There is no proofing stage for truForm. Forms sent in are programmed “as-is.” If you would like to make additional design changes to either your personal form or our standard form (if you wish to change our standard form, design fees will apply at $150/an hour), please make sure the final version is ready for completion when information is sent to PBHS Support (you may also email [email protected]). If you decide to make additional design/programming changes to the form after completion, a programming fee of $150/page and a design fee of $150/hour will be incurred. Moving forward, please contact PBHS Support for a quote to make truForm changes.

Contact PBHS Support

Send Support an email!

We can be reached by phone directly at 888-840-0739.
Comments/Questions
Please click the "submit" button below to ensure your truForm setup information is recorded and sent to Support.

Thank you!
Initials
This field is for validation purposes and should be left unchanged.

TruForm

TruForm Consent Questionnaire

Step 1 of 5

TruForm Consent Questionnaire

TruForm Consent Setup Questions

1. Form Selection

Example Form: Alveoloplasty/Sequestrectomy Informed Consent

Example Form: Anesthesia Informed Consent

Example Form: Biopsy Informed Consent

Example Form: California Anesthesia Legislation

Example Form: Chemical Skin Peel & Treatment Informed Consent

Example Form: Cleft (Lip and Palate) Repair Surgery With Grafting Informed Consent

Example Form: Cleft Lip Repair Surgery Informed Consent

Example Form: Cleft Palate Repair Surgery Informed Consent

Example Form: Cleft (Lip and Palate) Repair Surgery With Grafting Informed Consent

Example Form: Coronectomy Informed Consent

Example Form: Dental Implant Informed Consent

Example Form: Dental Implant With Grafting Informed Consent

Example Form: Distant Site Graft Harvest Informed Consent

Example Form: Distraction Osteogenesis Surgery Informed Consent

Example Form: Ear Surgery (Otoplasty) Informed Consent

Example Form: Eyelid Surgery (Blepharoplasty) Informed Consent

Example Form: Facelift Surgery (Rhytidectomy) Informed Consent

Example Form: Facial Augmentation (Implant) Surgery Informed Consent

Example Form: Facial Filler Injection Informed Consent

Example Form: Facial Liposuction Informed Consent

Example Form: Facial Reconstruction and Fracture Repair Informed Consent

Example Form: Frenectomy Informed Consent

Example Form: Incision and Drainage Informed Consent

Example Form: Jaw Joint Arthrocentisis / Arthroscopic Surgery Informed Consent

Example Form: Jaw Joint Surgery Informed Consent

Example Form: Laser Skin Resurfacing Informed Consent

Example Form: Laser-Assisted Uvulopalatoplasty (LAUP) Informed Consent

Example Form: Nasal Surgery (Rhinoplasty) Informed Consent

Example Form: Nerve Lateralization Informed Consent

Example Form: Nerve Repair Surgery Informed Consent

Example Form: Neurotoxin Injection Informed Consent

Example Form: Orthognathic Surgery Informed Consent

Example Form: Osteogenic Orthodontics Informed Consent

Example Form: Osteomyelitis Treatment Informed Consent

Example Form: Placement of Temporary Anchorage Device Informed Consent

Example Form: Salivary Duct Stone Removal Informed Consent

Example Form: Salivary Gland Removal Informed Consent

Example Form: Scar Revision Surgery Informed Consent

Example Form: Sinus Surgery Informed Consent

Example Form: Soft and or Hard Tissue Grafting Informed Consent

Example Form: Surgical Exposure and or Bracketing of Impacted Teeth Informed Consent

Example Form: Surgical Root Canal (Apicoectomy) Informed Consent

Example Form: Surgical Tooth Repositioning Informed Consent

Example Form: Tooth Extraction Informed Consent

Example Form: Tooth Extraction with Grafting Informed Consent

Example Form: Tracheostomy Informed Consent

Example Form: Treatment of Cysts or Tumors Informed Consent

TruForm Setup Questions

3. Your TruForm user account

You've almost completed your TruForm setup questionnaire, PLEASE SCROLL DOWN TO SUBMIT!

Additional truForm information

Contact PBHS Support

Please click the "submit" button below to ensure your truForm setup information is recorded and sent to Support.

Thank you!