Completed Form for your comments. 

I need you all to point out which of the fields in the form are mandatory for patients to complete. The form creation process is not complete yet. After I get your feedback, the form will be completed, patient will be able to receive a pdf version of the form. 

Front office people will receive pdf version of the form

I will implement HIPAA compliant form submission protocol when then website is ready to lunch.  That has specific yearly cost.