Payment Integration

1

Patient

2

Type

3

Schedule

4

Review

Select Patient

Recent Patients

Loading recent patients...

Select Appointment Type

New Patient Visit

First time visit

Follow-Up Visit

Returning patient

Annual Physical

Yearly exam

Wellness Exam

Preventive care

Consultation

Specialist consult

Telehealth

Virtual visit

Procedure Visit

In-office procedure

Urgent Visit

Same-day / walk-in

Lab Review

Review lab results

Medication Review

Med management

New Longevity Patient

First longevity consultation

Follow-Up Longevity Patient

Continuing longevity care

Filter Slots

Provider

Date

Custom Time (optional)

Notes (optional)

Available Slots

Loading available slots...

Configure Recurring Pattern

Provider

System will auto-assign available providers

Days Per Week

Mon Tue Wed Thu Fri Sat Sun

Duration

weeks

Preferred Time

Notes (optional)

Appointments Preview 0 total

Select days to see appointments

Review Before Saving

Patient -

Appointment Type -

Duration -

Date & Time -

Provider -

Notes -

Patient Reminders

24 hours before

1 hour before

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

Location Name *

Address

City

State

ZIP

Phone

Facility NPI

Exactly 10 digits, or leave blank.

Place of Service

Tax ID

Taxonomy Code

Submitter ID

Timezone *

All appointment times will be displayed in this timezone for users at this location.

Set as primary (default) location

Enable Longevity for this Location

When enabled, patients filling intake at this location will see the Longevity section. Clinicians will see the longevity data in the patient profile and encounter intake panel.

Assign to Clinic *

First Name *

Last Name *

Date of Birth *

Gender

SSN

Phone

Email

Address

City

State

ZIP

Provide emergency contact information for the patient. This will be used in case of emergencies.

Contact Name

Relationship

Phone

Alternate Phone

Primary Insurance

Insurance Type

Payer

Member ID / Policy Number

Group Number

Cost Sharing

Copay ($)

$

Fixed amount per visit

Coinsurance (%)

%

% patient pays after deductible

Deductible ($)

$

Annual deductible amount

Subscriber Information

Relationship to Patient

Subscriber First Name

Subscriber Last Name

Subscriber DOB

Subscriber Address (Box 7)

Subscriber City

Subscriber State

Subscriber ZIP

Subscriber Gender (Box 11b)

Insurance Verification

Secondary Insurance (Optional)

Insurance Type

Payer

Member ID / Policy Number

Group Number

Subscriber Information

Relationship to Patient

Subscriber First Name

Subscriber Last Name

Subscriber DOB

Subscriber Address (Box 7)

Subscriber City

Subscriber State

Subscriber ZIP

Subscriber Gender (Box 11b)

Insurance Verification

Upload patient documents such as insurance cards, ID, referrals, or medical records. All files are encrypted at rest for HIPAA compliance.

Document Category

Description (Optional)

Upload Documents

Drag and drop files here or click to browse

Supported: PDF, JPG, PNG, DOC, XLS, TXT (Max 10MB each)

Uploaded Documents

File Name	Category	Size	Uploaded	Actions

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

AI-generated clinical notes may contain errors. Please review and verify all documentation before signing.

Appointment

Date:

-

Time:

-

Type:

-

Patient

Name:

-

Provider

Name:

-

Select Note Templates Choose which notes to generate from this recording

Loading templates...

Not Started

00:00

Elapsed Time

Your recording session is saved automatically. You can pause and resume at any time.

Patient

Time

Type & Status

Reason for Visit

Clinical Notes

Loading notes...

Assign to Clinic *

First Name *

Last Name *

NPI *

Credentials

Specialty

Taxonomy

Email

Phone

License Number

License State

License Expiry

Default Appointment Duration (min)

Profile Color

Active

Work Schedule (Duty Hours)

Set the provider's working hours for each day. Available slots will be generated based on this schedule.

Day	Available	Start Time	End Time
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Provider Signature

Upload a signature image (JPG or PNG) that will be used when signing clinical notes with the {{provider_signature}} placeholder.

No signature uploaded

Upload Signature Image Max 2MB. JPG or PNG format.

Co-Sign

For clinicians who cannot be billed yet. Their encounters are reviewed and co-signed by the selected provider before a claim is created.

Requires co-sign

User Account (Auto-Created)

A user account will be automatically created for this provider using the email above.

Password *

Required for user account creation

Clinic Information

Clinic Name *

Phone

Email

Address

City

State

ZIP

Tax ID

NPI

Plan

Initial Location

Location Name *

Time Zone *

This will be the default location for this clinic. You can add more locations later.

Clinic Administrator

Admin First Name *

Admin Last Name *

Admin Email *

Admin Password * Minimum 8 characters

Assign to Clinic *

First Name *

Last Name *

Email *

Phone

Role *

Password *

Minimum 8 characters

Provider Association

Link to Provider Select a provider if this user is a clinician account

No Provider

Active

Create HTML templates with placeholders that will be replaced with actual patient and clinic data when generating the PDF.

Template Name *

Status

Active (available for use)

Description

Clinic * Template will be available only for this clinic

Location * Template will be used for this specific location

Available Placeholders

Patient Information

{{PatientName}} - Full name
{{PatientAddress}} - Full address
{{DateOfInjury}} - Date of injury

Attorney Information

{{AttorneyName}} - Name
{{AttorneyAddress}} - Address
{{AttorneyPhone}} - Phone
{{AttorneyEmail}} - Email

Provider Information

{{ProviderName}} - Name
{{ProviderSignature}} - Signature image

Clinic Information

{{ClinicName}} - Clinic name
{{ClinicAddress}} - Full address
{{ClinicPhone}} - Phone number
{{ClinicEmail}} - Email address

Other

{{TodayDate}} - Current date

Template Content (HTML) * Use the placeholders above to insert dynamic content

Send Registration Link

Enter the patient's name and email. A new patient record will be created and a registration link will be sent for them to set up their portal account and complete their profile.

First Name *

Last Name *

Email Address *

Invitation History

Patient	Email	Status	Sent	Actions
Loading...

Verify Your Identity

User

Reset Password