HIPPA Compliant Custom Sign-In Log

Custom Sign-In Systems

Recent HIPAA regulations require that patient privacy be protected, EVEN in public waiting rooms. And now compliance just got easier with our sign-in systems.

This Sign In Sheet is designed especially for patient sign-in, but can easily be customized to suit your specific office needs. The patient signs in on the label shown below and staff removes it to affix in the chart. The unique design prevents future patients from viewing the duplicate log showing names of those that signed in before them.

the number of columns, the size of columns, and header are customizable.


This two-part label/form keeps patient information confidential and creates an automatic duplicate log of all patient sign-in activity.


20 entries per 8 1/2 x 11 form 100 sheets per box 2,000 entries total per box


  • Your Logo & information at the Top of Each form
  • Custom Columns to fit your office needs
  • Includes duplicate log
  • HIPPA Complaint
  • Easy Reorder

Call for special pricing

As low as $117 for 100 Sheets

One Time Set up fee for custom design $45.00  (Kern County Medical Society Member Discount only $20 for Custom Design)

Fast Turnaround

72hr turnaround plus shipping time

Job Specifications

  • Print Details $0.00

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    • This realtime quote does not include tax or shipping.