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Blue Confidential Patient Sign-In Label Forms, 8-1/2" x 11", 23 Peel Off Adhesive Sign In Lines (125 Forms per Pack)

Item Number: S-14531
22 reviews


Price per
Pack of 125

$61.29 $56.65$54.29$53.66$52.75

Volume Savings7.6%11.4%12.4%13.9%

Need 30+ Packs? Click here for Pricing

  • HIPPA Compliant (HIPPA Privacy Rule, Section 164.502)
  • Second Sheet is a complete record of all patients seen that day
  • Option to call patients by name or number
  • Carbonless
  • Patient Privacy Sign-In Sheet
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Keep track of which patients come in to your healthcare facility or medical offices each day with these Blue Confidential Patient Sign-In Label Forms from The Supplies Shops. Each of these 8.5" x 11" HIPAA-compliant confidential patient sign-in sheets comes with 23 peel-off labels. This allows you to ensure that patient information remains confidential since it prevents other visitors from seeing details on the sign-in log. Once completed, you can remove the top portion to reveal the special backer, which will have a complete log of the patient visits for the day.

This form features a simple blue color background with fields for the following patient data: name, arrival time, appointment time, appointment with, new patient check box and a box to indicate a change of address, phone or insurance since the last visit.

  • 8.5" x 11" form size
  • 23 peel-off labels for confidentiality
  • Backer records complete log of patients
  • Blue color background
  • Carbonless
  • HIPAA compliant
  • 125 per pack
ASIN:B00NBB6UCMBackground Color:Blue
Brand:TabbiesFeature 6:A special back printing prevents writing from showing on the liner
Feature 7:Printing on the liner directs patients to sign the next lineFeature 8:125 Sheets / Pack
Pre-Printed:YesPackage Height:11 in
Package Weight:5.00 LBPackage Width:8-1/2 in
Material:PaperCountry of Origin:USA
Manufacturer Part Number:14531Number of Items:125
Paper Size:LetterSheet Length:11 in
Sheet Size:8-1/2 x 11 inSheet Width:8-1/2 in
Ships in:1 to 3 Business Days (Plus time in transit)Size:8-1/2 x 11 in
Text Color:BlackUPC:84371145317
Background Color:Blue
Feature 6:A special back printing prevents writing from showing on the liner
Feature 7:Printing on the liner directs patients to sign the next line
Feature 8:125 Sheets / Pack
Package Height:11 in
Package Weight:5.00 LB
Package Width:8-1/2 in
Country of Origin:USA
Manufacturer Part Number:14531
Number of Items:125
Paper Size:Letter
Sheet Length:11 in
Sheet Size:8-1/2 x 11 in
Sheet Width:8-1/2 in
Ships in:1 to 3 Business Days (Plus time in transit)
Size:8-1/2 x 11 in
Text Color:Black
Out of 5.0
Overall Rating
of customers that
buy this product give
it a 4 or 5-Star rating.
Five Star Excellence Award
Verified Buyer
December 23, 2020 by FIDELIS O
“I am very happy with my purchase and the promptness on delivery.”
Verified Buyer
December 8, 2020 by Ben S
“There is no space on the form to enter a couple of lines for a confidentiality agreement or some other type of text.”
Verified Buyer
June 4, 2020 by Sue H (AL, United States)
“All went well”

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