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A consent, an agreement or a policy that needs signing starts as a document you already have. Upload it once, say who signs it and where, and every copy you send afterwards carries the same fields in the same places. To begin from one another clinic has already prepared, or to share yours, see Share a document for signature with other clinics.

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Upload the document

1

Choose the file

On the eSignatures tab, select Send a document for signature, then Upload a new document and Choose a document. A PDF or a Word (.docx) file works. A document you have already prepared is listed in the same sheet — select Send beside it to choose who signs, or Add recipients or Place fields if it is not ready yet.
2

Name it

Give it a Name your team will recognise, such as “Consent for procedure”. The name is what you pick it by later.
3

Upload it

Select Upload and place fields. The file is checked and its pages are read before you can place anything, which can take a moment for a long document.

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Decide who signs it

A new document starts with one recipient, Patient, who signs. Change that before you place fields, because every field belongs to a recipient.
1

Open the recipients

Select Edit recipients. The panel is headed Who signs this document.
2

Name each person by their role

Use a role, not a person’s name — “Patient”, “Clinician”, “Witness”. Who fills each role is chosen when you send, so the same document works for every patient.
3

Say what each one does

Under What they do, choose Signs, Witnesses, Approves, Receives a copy or Signs in person. At least one recipient has to sign, witness or approve.
4

Set the order

Move a recipient up or down to change who goes first. Turn on Same step as the recipient above when two people can sign at the same time instead of one after the other.
5

Save

Select Add a recipient for anyone else, then Save recipients.

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Place the fields

Choose whose fields you are placing, then drag fields onto the page from the panel beside it. Fields are grouped under Signature, Contact Information, Inputs, Actions and Other. Select Save fields when every recipient has what they need to fill in.

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Ask the signer for a file or a photo

Place an Attachment field where you want a file, such as an insurance card or a previous report, or a Drawing field where you want a photo drawn onto the page. Both are under Other. Mark either one required if the document should not be signed without it. In an Attachment field’s settings you can narrow Allowed file types or lower Largest file (bytes). A signer can upload up to 10 files on one document.

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Put your clinic’s stamp on a document

A stamp is available on the Essential plan and above. Only the clinic owner or a manager can add or retire one.
1

Place the stamp

Drag Stamp from Actions onto the page and select it to open its settings.
2

Add your stamp image

Under Stamp image, select Add a stamp. Give it a Name, choose a PNG or JPEG of up to 2 MB, and select Upload stamp.
3

Wait for the check

Every image is checked for safety first, which usually takes under a minute. The stamp shows Checking… until then and cannot be chosen yet. When it is ready it is put on the field for you.
4

Choose it

Pick the stamp from Stamp image. A stamp you place for yourself is added to the finished document automatically; one you place for a recipient is added when they select Apply the clinic’s stamp.
To take a stamp out of use, select it and choose Retire this stamp. Documents already sent keep it, and documents already signed do not change.

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Send it

Select Send for signature. For each recipient you choose who they are and How they sign. To send to a patient, open Patient on that recipient and search by name or record number. Their name and email address fill in from their record — the email address of each patient is shown in the list before you choose. Each recipient chooses separately, so the patient, a guardian and a witness can each be someone different. For anyone who is not a patient — a guardian, a relative or someone outside your practice — leave Patient empty and type their Full name and Email; if you already chose a patient by mistake, select Not a patient — enter someone else. If the patient has no email address on file, the sheet says No email address on file. Type an address under Email for this send, or choose In person, on this device. An address you type for a patient — or type over the one on file — is used for this document only: it is not saved to their record. To keep a new address, update it on the patient’s record. Temporary and relay email addresses are not accepted. How they sign:
  • Emailed a signing link — the link alone opens the document.
  • Emailed a link, plus an access code you give them — type an Access code of 4 to 64 characters and tell it to them yourself, by phone or in person. It is never emailed, and only a scrambled copy is kept, so nobody at the practice can look it up later; if they forget it, send the document again with a new one. Eight wrong tries lock the link; send the document again to give them a fresh one.
  • Emailed a link, plus a code texted to their phone — add their Mobile number, starting with + and the country code. When they open the link they select Text me a code and type the six-digit code, which works for 10 minutes. They can ask again after a minute, up to five texts a day. Offered only when your plan includes text-message appointment reminders (Essential and above — not the Pharmacy or Diagnostics plans) and your practice has a text-message number under Settings → Communications. Each plan includes a number of texted codes a month — 50 on Essential, 500 on Team, no limit on Enterprise — counted across every document; the count on Forms shows how many you have used.
  • In person, on this device — for someone sitting with you. Before they can select Finish, a member of staff signed in on the device selects Confirm the signer’s identity and then I confirm this person’s identity; that confirmation is printed on the certificate of completion. The member of staff who confirms needs the Send documents for signature permission, and — if your practice requires two-factor authentication — must have signed in with their second factor. When more than one person signs in person in turn, open the next one from the envelope’s page: the person whose turn it is has Sign here now beside their name.
Once they have typed their code and opened the document they are not asked again while they sign; a link you send them again asks again. You can also set a Signing order, what happens If somebody declines, and Ask signers to finish by (optional), then review and send. Following it up afterwards is covered in Send a form.

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What signers see when you ask for a file

The signer selects the box and chooses a file from their phone or computer. While it uploads they see Uploading your file…, then Checking the file… while it is checked for safety. That usually takes under a minute, and they can keep filling in the rest of the document. The box is filled only when the check passes. A file that does not pass the check is never attached. The signer is told That file did not pass our safety check, so it cannot be used and can choose a different one. A file of the wrong kind, or one that is too large, is refused straight away with the limit. When everyone has signed, the finished copy is sealed with its certificate of completion. With the document seal, it also carries a digital signature in your organisation’s legal name that PDF readers show as trusted. A photo from a Drawing field and your stamp are drawn onto the page where you placed them. Each attached PDF or image is added to the finished copy as extra pages after the document, the Attachment box says which page it starts on, and the certificate of completion lists each attachment with its fingerprint. The name of the file the signer uploaded is not printed.

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Open a file a signer attached

On the envelope’s page, Files from signers lists every file a signer uploaded, who uploaded it and whether it has been checked. Select Open to view it in your browser or Download to save a copy. The links last five minutes. Opening and downloading are both recorded in the audit log, and a file still being checked, or one that failed the check, cannot be opened. You need the View form responses permission to see this list.

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Download the signed copy

Once everyone has signed and the document is sealed, the envelope’s page offers Signed document and Certificate. Each gives you a download link that lasts five minutes. You need the Export form responses permission to download either one, because the copy leaves the practice. Every download is recorded twice: in your audit log, with who took the copy, and on the envelope’s own timeline. A document is only sealed when every person who had to sign, witness or approve has actually done so. If a recipient’s document has a Clinician licence box and that person has no licence saved on their profile when the document is sealed, the box stays blank and the certificate of completion says so under Professional licence, rather than printing nothing without explanation.

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Check it worked

The document appears on the eSignatures tab with each recipient and where they have got to. Open it again from the builder and the recipients and fields you saved are all still there.

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If something goes wrong

The file could not be read. Save it as a PDF and upload it again.
The document is still being checked and prepared. Leave the page open — it opens the document by itself when it is ready — or select Check again after a minute.
They still have fields on the document. Move those fields to another recipient or delete them, then remove the recipient.
It appears only when your plan includes text-message appointment reminders (Essential and above; no Pharmacy or Diagnostics plan includes them) and a text-message number is set up under Settings → Communications. Use Emailed a link, plus an access code you give them instead, or set up texting first.
Check the mobile number on the request starts with + and the country code. They can select Text me a code again after a minute, up to five times a day. If it still does not arrive, send the document again with Emailed a link, plus an access code you give them and read them the code.
Your practice may have used this month’s texted codes — 50 on Essential, 500 on Team. Nothing is sent once they are used up, and each refusal is recorded in your audit log as Signing codes by text per month. The count starts again on the first of the month; to text more codes sooner, upgrade your plan — see Change your plan. Until then, send the document with Emailed a link, plus an access code you give them.
The safety check usually finishes in under a minute. If the page was closed, the file is still saved; when the signer opens the document again it shows whether the file passed. On the envelope’s page, select Check again under Files from signers.
A stamp that is still Checking… or that Failed the safety check cannot be chosen. Wait a minute for the check, or upload a different image. Add a stamp is refused unless you are the clinic owner or a manager and your plan is Essential or above.
The message You cannot host a signing for this clinic means the person signed in on the device is not allowed to confirm identity here. They need to be a member of this practice with the Send documents for signature permission, and, if your practice requires two-factor authentication, to have signed in with their second factor. An owner or manager can grant the permission from the team member’s permissions.
You need the Export form responses permission. If you have it and still see That download could not be recorded, so it was not started, sign in again — your practice may require two-factor authentication for patient records.
Type at least two characters of their name, or their record number. A client whose record is restricted to other members of staff is listed only by their secure label and cannot be chosen — ask a member of staff who can see their record to send it.
The address is a temporary or relay address, which cannot be used for a signing link. Ask the person for the email address they normally use, or choose In person, on this device.
Fields can be placed and saved on any plan. Sending a document to real recipients starts on the Essential plan (Clinic & Hospital) or the Starter plan (Pharmacy, Diagnostics) — see Change your plan.