Pain Management Center Authorization Release Form

Form Template

The Pain Management Center Authorization Release Form mobile app allows patients to authorize the release of healthcare information using a Smartphone or tablet.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

The app records patient name, date of birth, address, request and authorization and reason for request. This app can easily be made HIPAA secure for your patients privacy. GoCanvas allows you to replace your paper-based forms and processes with customizable mobile apps that you use on your smartphones and tablets.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
Read More
Platforms
  • iPhone
  • iPad
  • Android
  • Windows
Read More
Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us