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Best 3rd party form integration services for Medical Forms?

I’m creating an Orthodontist Website, and my client wants to have their new patient forms on the site, so the patient can submit a form, and have it sent to them before the patient comes into the office.

Does anybody know a good 3rd party company that can handle medical type forms that require a lot of information, and also check boxes. I was looking into mailchimp on the university page, but it seems that mail chimp only handles newsletter signup forms.

Any advice would be appreciated.

http://www.bockortho.com/

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