# Accept Medical Payments Online | Jotform + Square Healthcare

# Squ are Healthcare Forms

Securely collect medical data and fee payments online with Square and Jotform.

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https://www.jotform.com

Jotform Square Payment Form

Full Name

Next

My Products

Medical Mask

$10.00

Medical Glove

$10.00

Previous

Next

Credit Card Information

Credit Card Number

 

Expiration Date

 

Security Code

 

Previous

Submit

Your payment is received with

## All-in-One Medical Form Builder

Create forms that facilitate HIPAA compliance to collect health data, schedule appointments, receive informed consent, conduct surveys, collect bill payments, and more.

![Image 1: Build Your Medical Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/1.png?v=1.0.0.0)
### Build Your Medical Form

Use our drag-and-drop Form Builder to create forms that help you comply with HIPAA for your healthcare practice.

![Image 2: Add Square](https://cdn.jotfor.ms/p/square/healthcare/assets/img/2.png?v=1.0.0.0)
### Add Square

Select Square from the list of payment gateways and connect your Square account.

![Image 3: Treat More Patients Faster](https://cdn.jotfor.ms/p/square/healthcare/assets/img/3.png?v=1.0.0.0)
### Treat More Patients Faster

Start collecting important patient information and payments online!

## Secure Medical Payments

[![Image 4: Consent Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-1.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 5: Examination Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-2.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 6: Registration Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-3.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 7: Consent Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-1.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 8: Examination Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-2.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 9: Registration Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-3.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 10: Consent Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-1.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 11: Examination Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-2.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[![Image 12: Registration Form](https://cdn.jotfor.ms/p/square/healthcare/assets/img/form-3.jpeg)](https://www.jotform.com/square/healthcare/?jfNext=1)

[Use this template](https://www.jotform.com/square/healthcare/?jfNext=1)

## Accept Bill Payments with No Extra Fees

Jotform never charges additional transaction fees for collecting money through your forms. You just have to pay the standard Square rate.

![Image 13: Podo](https://cdn.jotfor.ms/assets/img/landing/payments/podo.png?v=1.0.0.0)
Put patients over paperwork with Square, the payment gateway trusted by healthcare businesses around the world. By making it easier to accept online payments for medical treatments and prescriptions, Square takes care of business for you and assists your practice with HIPAA compliance — so you can focus on connecting with and treating your patients.

W hen you integrate Square with Jotform, your healthcare organization can seamlessly process medical payments online, without paying Jotform any additional transaction fees. And if you’re worried about protecting patients’ payment data online, both Jotform and Square offer PCI compliance — keeping your online transactions safe and secure.

To take advantage of Jotform’s HIPAA compliance features, you must first upgrade to a Gold plan and sign a Business Associate Agreement (BAA). Then you can use one of our free form templates or create a form from scratch to build forms that enable HIPAA compliance. Embed the form in your website, or share it with a link.

![Image 14: This Dentist Uses Jotform & Square to Get Paid Quickly](https://cdn.jotfor.ms/p/_templates/payment-scss/assets/img-min/video-blank.png)

### This Dentist Uses Jotform & Square to Get Paid Quickly

Dr. Cynthia Brattesani owns a top dentistry office in San Francisco. To keep her practice running, she needs to get paid. She used to collect payments through paper statements, but knew there had to be a better way. [That’s when she started using Jotform and Square](https://www.jotform.com/blog/dr-brattesani-case-study/).

## Build Your Own Payment Form

Create an account and start receiving payments!

Create a Free Payment Form

**JOTFORM ENTERPRISE**

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