Online Patient Submission Form

Online Patient Submission Form

I need an online form that can be embedded into my website. I currently use Wufoo to produce the following form information: Patient Name, Date of Birth etc. In my form, certain radiology scans are uploaded from an USB source to my form and an email notification and the document is sent to me. I want a new form that uploads the same information but that removes the files from the USB source upon upload.


Budget : N/A | Duration : 3 days

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