Configure Your Plan

HIPAA Compliant emails with a Business Associates Agreeement (BAA) via Hushmail. For 2 or more emails, you can have the maximum amount of HIPAA Compliant Secure Customizable Intake Forms for each package tier (ex: Up to 5 forms for the 5 email package)

Update Totals

Coupon code

Customer Information

First Name *

Last Name *

Email Address *

Phone

Organization

Billing Information

All transactions are secure and encrypted.

First Name on Account *

Last Name on Account *

Card Number *

CVV

Expiration Month *

Expiration Year *

Billing Address

Address 1 *

Address 2

Billing Country *

Billing City *

Billing State *

Billing ZIP Code *

I accept the Terms and Conditions

Recurring Fee (every 1 month)	$125.00
Today's Total	$125.00
then $125.00 at first renewal on May 18, 2024