HIPAA Compliant Web Forms

What HIPAA Compliant Web Forms does

HIPAA Compliant Web Forms, operated by Code Monkeys LLC, provides a WordPress plugin that enables healthcare organizations to collect patient information online in a HIPAA-compliant manner. Founded in 2018 by Ed Paulsen and based in Hammond, Wisconsin, the product integrates with the two leading WordPress form builders — Caldera Forms and Gravity Forms — so that web developers and healthcare operators can assemble patient intake, contact, and consent forms without building custom compliance infrastructure themselves. The company supports secure form submission, file uploads, and Business Associate Agreement-backed handling of protected health information (PHI), positioning itself as a regulatory-fit alternative to general-purpose form plugins for U.S. healthcare use cases.

The business model is a tiered, freemium subscription aimed at small and mid-sized healthcare providers, the web designers and developers who build sites for them, and insurance agencies. A free tier offers one form and 25 submissions per month; the Standard tier is priced at $65/month, $190/quarter, or $715/year; the Plus File Upload tier is $95/month, $270/quarter, or $1,015/year; and a $100 one-time setup service is offered. There is no disclosed external funding, no published headcount, and a single named customer testimonial (Medical Advertising Professionals / VPINTEA), indicating a small, founder-operated operation.

In June 2026 the company is preparing to release Akashic Health Records, an adjacent electronic health records product that would extend the offering beyond form collection into broader clinical record keeping, while the core plugin continues to receive iterative updates (version 3.3.0). All publicly visible activity is U.S.-focused, and there are no signals of geographic expansion or external investment to date.

Name

HIPAA Compliant Web Forms

Legal name

Code Monkeys LLC

Website

https://hipaaforms.online

Company type

Private

Founded year

2018

Operating status

Operating

Short description

HIPAA Compliant Web Forms is a WordPress plugin, operated by Code Monkeys LLC, that lets U.S. healthcare providers and web developers build HIPAA-compliant online intake, consent, and contact forms, with a freemium subscription model starting at $65 per month.

Ownership category

akta.pro rank

Product category

HIPAA Compliance Software

NAICS

Software Publishers (5132)

SIC

Services-Prepackaged Software (7372)

akta.pro industry

PRIMARYHLACACAE

Patient Access, Registration & Intake (Front-End RCM)

Healthcare & Life Sciences/Digital Health & Health IT/Revenue Cycle Management (RCM) & Billing Software

Keywords

• HIPAA compliant forms
• WordPress form plugin
• Secure web forms
• Healthcare data collection
• Encrypted form submission

Headquarters

HQ city

Hammond

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Technology or R&D, Personnel, Infrastructure, Marketing or Sales, Operations

Revenue model

1. Basic Free Tier: Free subscription tier offering 1 active form and 25 submissions/month. Generates revenue through conversion to paid Standard plans. No credit card required.
2. Standard Subscription Plans: Paid subscription tiers providing unlimited forms and submissions. Available in monthly ($65), quarterly ($190), and annual ($715) billing cycles. Includes 1 live domain and 1 staging domain.
3. Plus File Upload Subscription: Standard subscription with unlimited file upload capability. Available in monthly ($95), quarterly ($270), and annual ($1,015) billing cycles.
4. Setup Service: One-time $100 fee for plugin installation, configuration, and creation of one HIPAA-compliant form. Professional services for customers who need hands-on assistance.

Pricing tiers

Go-to-market motion2 records

Distribution channels2 records

Marketing channels3 records

Core offering

Code Monkeys LLC sells HIPAA Forms, a WordPress plugin plus API service that converts forms built with Caldera Forms or Gravity Forms into HIPAA-compliant forms by encrypting submissions and storing E-PHI on HIPAA-compliant infrastructure separate from the customer's hosting server. The product includes drag-and-draw digital signatures, secure password-protected PDF generation, role-based form separation by clinic or doctor, audit-grade access logging, and a Business Associate Agreement (BAA). Subscriptions are offered as a free Basic tier (1 form, 25 submissions/month) and Standard or Plus paid tiers (monthly, quarterly, or annual), with an optional $100 one-time Setup Service for installation and configuration.

Product overview

HIPAA Compliant Web Forms offers a WordPress plugin and API service that enables healthcare organizations to securely collect and store patient information through HIPAA-compliant web forms. The core offering consists of HIPAA Forms Basic (free, limited to 1 form and 25 submissions/month) and Standard tier subscriptions (unlimited forms and submissions at $65/month, $190/quarter, or $715/year). Optional file upload add-ons are available for $30/month or $300/year additional, combining with Standard plans to create Plus File Upload tiers. A one-time $100 setup service is also offered. The plugin integrates with Caldera Forms (free) or Gravity Forms (premium) form builders, encrypts and transmits form data to HIPAA-compliant storage via the company's API, and allows secure PDF generation of submitted forms. The company is developing Akashic Health Records as a future patient-centered coordination platform and portal to extend beyond form collection into broader healthcare information management.

Differentiator

Problem solved

Functional benefit

Brands

• Akashic Health Records: A patient-centered, real-time healthcare coordination platform and patient portal embedded within an organization's WordPress domain, designed to help organizations collect information, manage information, coordinate care, and engage patients

Products and services

• HIPAA FORMS
• HIPAA FORMS Setup Service

Quantifiable outcome

• Patients spend over 20 minutes on average filling out forms in office

Named customers1 record

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

Feature8 records

Partnerships

Two partnerships are on record, tiered core.

• Caldera FormscoreTechnology or IntegrationFree WordPress form builder plugin integrated with HIPAA Forms. Preferred form builder due to being free and simple to use. Forms created with Caldera can be designated as HIPAA compliant with a single checkbox.
• Gravity FormscoreTechnology or IntegrationPremium WordPress form builder plugin integrated with HIPAA Forms. Popular paid form builder that can be designated as HIPAA compliant. No additional extensions needed for HIPAA compliance.

Scale indicators3 records

Recent moves5 records

Expansion highlights3 records

Emerging players

• WPForms: Popular WordPress form builder with a growing ecosystem of add-ons; relevant peer as another WordPress-native form option that could expand into HIPAA-compliant tiers over time.
• 123FormBuilder: Web-based form builder with HIPAA-compliant option and healthcare templates; comparable in secure healthcare data collection, with a similar self-serve SMB orientation.
• Formidable Forms: Advanced WordPress form builder with calculation and view features; comparable in targeting WordPress-based form workflows and a potential add-on HIPAA partner or competitor.

Broad incumbents

• Typeform: Widely-used conversational form and survey platform with healthcare use cases; competes for online patient intake and registration workflows though not WordPress-native.
• Tebra (formerly PatientPop): Practice growth and EHR-adjacent platform for independent healthcare practices; relevant as an adjacent buyer of HIPAA-compliant intake and forms workflows in the SMB healthcare segment.
• SurveyMonkey (Healthcare): Large-scale survey and form platform with HIPAA-compliant enterprise offering; competes for healthcare data capture use cases with a much broader product portfolio.
• Gravity Forms: Leading premium WordPress form builder that HIPAA Forms integrates with; a potential competitor if it ships native HIPAA features, but currently a channel partner rather than a rival.

Direct peers

• Formstack: Healthcare-focused online forms and workflow automation with HIPAA compliance and BAA support; comparable in targeting healthcare forms and secure data capture, though broader than WordPress-only.
• JotForm: Offers a HIPAA-compliant tier of its online form builder targeted at healthcare organizations; directly competes in the same secure-form-for-healthcare-E-PHI category with a broader, non-WordPress platform.
• Cognito Forms: Online form builder with a HIPAA-compliant offering and BAA for healthcare customers; competes for the same healthcare form collection use case with similar encryption and compliance positioning.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about HIPAA Compliant Web Forms