Request Your Healthcare Snapshot

What this is

✓ HIPAA Security Rule quick-check
✓ Interoperability readiness assessment
✓ Information blocking risk review
✓ System cost analysis
✓ Prioritized PDF action plan you keep

What this is not

— Not a full HIPAA audit
— Not a penetration test
— Not a vendor negotiation
— Not a sales pitch or upsell mechanism
— Not legal or clinical advice

How we handle your information

✓ We do not request passwords, credentials, or admin access
✓ We do not access patient data or PHI
✓ Approximate ranges are perfectly acceptable
✓ Your data is never shared, sold, or used for any other purpose
✓ Deletion available upon request at any time

No PHI collected

No admin access needed

Estimates are fine

Data never shared

No obligation

⏱ Time Commitment

Intake Form

8–12 min

Diagnostic Call

60 min

Report Delivery

72 hours

We only request high-level information. Exact numbers aren't necessary—approximate ranges are fine. No passwords, system access, or patient data required.

Contact Information

So we can reach you to schedule the diagnostic call.

Name *

Email *

Phone (optional)

Practice Name

Your Role

Practice Context

Helps us calibrate the assessment. Estimates and ranges are fine.

Practice Type *

Number of Providers

Total Staff (approx.)

EHR / Practice Management System

IT Support Model

Approx. Monthly Software Spend

Compliance & Operational Concerns

Select what's driving this request. Check all that apply.

HIPAA security gaps (MFA, encryption, access) Interoperability / FHIR readiness Information blocking concerns Systems don't talk to each other Software costs feel too high Too much manual work / data re-entry No recent risk assessment Not sure where we stand overall

What's your #1 concern right now? (1–2 sentences)

Current Systems

List the main tools beyond your EHR. Don't worry about being exhaustive—we'll fill gaps on the call.

Tools by category (list what comes to mind)

Workflows to Focus On

Select up to 3 workflows you'd like us to assess during the diagnostic.

Patient intake & registration Scheduling & appointments Referrals & care coordination Billing & claims processing Patient communication (reminders, follow-ups) Compliance tracking & documentation Reporting & dashboards Staff onboarding / offboarding

For your top workflow: where does it break or slow down? (optional)

Scheduling

We'll confirm the exact time by email after reviewing your intake.

Preferred Call Type

Your Timezone *

Best Times * (list 2–3 windows)

Pilot Program: The first 3 Healthcare Snapshots are free. Regular pricing: $750 per assessment. No obligation to continue beyond the Snapshot.

I understand this is a high-level compliance and operational assessment, not a full HIPAA audit, penetration test, security audit, or legal review. Recommendations are directional and based on the information provided. No patient data or PHI will be collected or accessed.

Your information is never shared, sold, or used for any other purpose. We'll respond within 1 business day to confirm your call time.

What happens after you submit

We review your intake — within 1 business day
We email you to confirm a 60-minute diagnostic call
We have the call — structured assessment covering systems, compliance, and costs
You receive your Snapshot report — PDF with compliance scores, cost analysis, and prioritized action plan within 72 hours

Healthcare Compliance Snapshot

What this is

What this is not

How we handle your information

⏱ Time Commitment

What happens after you submit