Using Forms in Google Workspace
Updated: Aug 20
An important part of any EHR is having secure forms you can use. How does Google Workspace stack up?
Google Workspace has a forms application called, creatively, "Google Forms." It is secure, HIPAA-compliant, and relatively easy to use. It has pretty much everything you’d need for your average contact form, or intake form, or release form, or whatever – checkbox questions, text boxes, scales, etc. (If you’re doing more atypical things like a tree-person-house drawing, you may be beyond what Google can do for you though.) And it comes as part of the package you’re already paying for! So it’s got some pretty solid pros there.
On the other hand, there are a few cons. First of all, it’s not too aesthetic and there’s not a lot of customization you can do with the way it looks (which is probably fine for most users who don’t want to have to tinker with every little setting anyway).
The bigger drawback though is that there is no e-sign feature in Google Forms. There are several ways to handle this, but each of them has its own drawbacks:
1. Have clients type in their name.
This is a legal form of signature, however, my understanding is that if push ever came to shove and a client claimed they never signed off on your terms of consent, you would have a rootin’-tootin’ hard time proving in court that they did. (Note: please remember one of my favorite mottos: never take legal advice from a social worker. I highly recommend you ask an attorney before making any decisions about legal things.)
So, you can do this, but it’s not a very robust option legal-wise. If you do go this route, you’d also want to have a box for them to check indicating that they agree that their typed name should act as their signature, and offer an alternative way to sign in case they don’t (which could just be sending them a PDF of your form).
2. Have them upload an image of their signature.
You can have an “upload file” question asking for their signature, and they can just snap a photo of their signature with their phone, or go to https://www.signwell.com/online-signature/draw to draw one online quickly. The problem with this is that the client has to have a Gmail account to upload a file in this way. (In theory they can create one for free on the spot, but that generally doesn’t seem like a small barrier to most people. Not a super-streamlined option.)
3. Use a PDF form instead.
You can create a fillable PDF of your forms (www.pdfescape.com is a free tool for doing that), so that clients can fill out the PDF on their computer without having to print and scan (and they’d use an image of their signature there as well by inserting it in Acrobat Reader). The major problem here is that then you need them either to upload the PDF (same problem as above), or email it to you, which is not so HIPAA-friendly (see this post on Gmail and HIPAA).
The same problem exists with the old-fashioned way of having them download a PDF form, fill it out, and scan it in – no good way to get it back to you.
4. Use a signature add-on.
Currently the only HIPAA-compliant add-on I’m aware of that integrates e-signatures into Google Forms is DocuSign; but that’s an added cost, and for the HIPAA-compliant tier, you have to buy the highest level – the one where they don’t give you a price on the website (yikes!). The tier below that is $40/month. So it’s likely not a cheap option.
I recently came across Signature, another add-on that will sign a BAA, but unlike DocuSign, the signature field doesn't go right into the form; the client gets a separate notification. They have a free option for a few signatures a month, or a payment plan where you pay something like 40 cents per signature. Seems like a decent price! I have not tested this add-on extensively, largely because by the time I found it I don't personally need it, and it is unfortunately also not super easy to use.
The other add-on you can use is FormPublisher. This is a pretty decent solution, and they will give you the BAA for HIPAA compliance even with the free plan. The free plan allows for 20 submissions a month. (If you have more than 20 new clients a month, you can probably afford their paid plan, which is only $70 a year.)
FormPublisher is not primarily for signatures, actually – it does a host of nifty things, and it offers you the ability to automate some stuff (like getting a nicely formatted PDF when someone submits a form, which Google doesn’t do for you). That said, it’s not perfect because 1. it’s not super intuitive to use, and 2. you can’t integrate the signature directly into the form – instead, the client fills out the form then gets another email to click a link and sign (and you cannot customize that email). You can actually see what it’s like if you sign up and ask for a BAA – they use their own product to have you sign it.
I used FormPublisher for a while and was happy with it, but it does have those disadvantages.
5. Check out this creative and clunky solution I came up with.
If you go to https://www.workspaceehr.com/signwithgoogle you'll see a way you can have users draw a signature using only Google products. The major drawback is that this only works on desktop and not mobile. (It's also not terrible elegant.)
So the other way to go here is to not use Google Forms at all and go with an outside forms-er, which is what I started doing recently, and I have no regrets. JotForm has been excellent in a couple of ways:
First, of course, it’s HIPAA compliant (and they’re serious about it, beyond just signing the BAA).
But more than that, it’s a very flexible and customizable platform, while still being very user-friendly, so you can get a lot done without having to get into anything technically demanding. It integrates nicely with Google, so you can still get a Google Sheet with all the info in one place. You can also get PDFs of the intake forms or whatever you need emailed to you or just plunked right into your Google Drive. It has lots of other integrations, like PayPal payment forms, calendar scheduling (not a super feature yet, but hopefully getting there), and all kinds of good stuff like that, plus many, many options for question types you might need – rating scale? YouTube video? Map? – including the ever-so-needed built-in e-signature feature.
My favorite thing about JotForm, though, is the way I’ve been able to use it to set up automations for a variety of things. When someone books a first session with my practice, the following things happen automatically: I get an email with the details of the client and appointment; the client gets an email with the time and date of the session as well as links to the online intake form; the therapist they’re meeting with gets a confirmation email; and the client details get put into a referral spreadsheet for the therapist. Then, when the client fills out the intake, it shows up as a PDF in Google Drive (which is where I keep all my records anyway)! It’s been really nice to have all these smalls tasks automated in this way.
I am describing here only a small portion of the capabilities JotForm has. I continue to find out about more features I can make use of! And they have premade templates of lots of useful things (like payment forms, consent forms - 720 kinds of consent forms! - and more). So, as you can tell, I’m a big fan of JotForm. (I even signed up for their affiliate program, so if you sign up through my link I’ll get a bit of a referral bonus!)
Oh, one more thing - their customer support is excellent. You post questions to their forum (privately if you wish) and they answer usually within a few hours!
The main hump to get over here is that the HIPAA-compliant plan costs $29/month. For solo practitioners I know that may not be a small amount. I have found it to be very worthwhile, but I’m not sure I would have gone for it when I was on my own either. You gotta make your own decisions.
2023 update: JotForm has very regrettably removed HIPAA compliance from the $29/month plan (unless you had it beforehand) and now it's $99/month for HIPAA compliance. Not a great option for most small or solo practices. :-(
A Note about Contact Forms
Many websites come with a contact form option as part of their package so potential clients can reach out to you. Sorry to break it to you (really I am), but you can’t use those (unless you’re using a platform made for therapists that is HIPAA compliant – but Wix or Squarespace of something, no). Contact forms need to be HIPAA-compliant as well.
Yes, I know that the person contacting you is not actually your client yet. Yes, I know it’s a big pain. Trust me on this one. I’ve researched this extensively, and here’s what I’ve found out:
There is no official answer on this. I have actually contacted the Department of Health and Human Services directly, through both official and unofficial channels, and did not get any response at all.
Every lawyer I’ve spoken to says that (although there is no official answer on this) you have to treat inquiries with the same level of confidentiality and HIPAA-compliance.
So, as always, make your own legal decisions. But I am pretty confident at this point that you do need a BAA with your contact form provider. (Yes, even if they say they don’t store the information.)
Google Forms works for this purpose, and the main issue is it’s just not very pretty. LuxSci has a good option for secure forms – you can get 3 form templates for $15/month (contact my buddy Eric at PMI Pros for that deal). But you may just want to spend a little extra and use JotForms, which has all the good stuff I mentioned above.
Got Questions about Forms?
It’s a lot, I know. I’m here to help! Feel free to reach out if you have any questions. I’ll update this post with more information if someone asks a good one!