Mira Forms

Your patients never fill out the same form twice.

Intelligent intake for orthopedic private practice. Returning patients confirm what you already know; everyone gets a short, dynamic form with only the questions this visit needs — coverage checked in real time, reminders by text and email, and a clean PDF into your EHR.

HIPAA-grade & signed BAA Built for orthopedic private practice

From the link they tap to the chart you open

Knows your patient

Never twice

Asks only what’s needed

Dynamic form

Verifies coverage live

Fewer denials

Reminds by text + email

Fewer no-shows

Lands in your EHR

Clean PDF

Sent by text — opens in one tap
Y Your practice
Almost done
Jane Rivera
03/14/1972

Your practice's branding, not ours — and returning patients open it already filled in.

The Real Cost

A cheap form doesn't cut the cost. It moves it to your staff.

Every generic intake tool collects answers and stops. The expensive part — the clinical and administrative work — still lands on the people you pay.

Mira closes all four.

That's the difference between buying a form and buying intake software.

01

Every submission re-typed by hand

Staff time

Front-desk hours lost to double data entry — and a fresh chance to fat-finger a date of birth or an allergy on every chart.

02

Denials that started at the desk

Lost revenue

A wrong member ID or an expired plan becomes a rejected claim weeks later — found long after it was cheap to fix.

03

Ninety-field forms patients abandon

No-shows & rework

Half-finished submissions mean clipboards at check-in anyway, more phone calls, and a thinner history for the visit.

04

Every visit starts from scratch

Repeat work

Returning patients re-enter the same demographics, insurance, and history they gave last quarter. Nothing carries over, so nothing gets faster.

Disability & Payer Forms

The forms nobody digitizes. Filled anyway.

FMLA certifications, disability-carrier forms, workers' comp paperwork — they arrive as someone else's PDF, and today a staffer fills them in by hand, one blank at a time. Upload one to Mira instead — even a crooked scanned fax — and AI maps everything the patient has already given you onto it: every form they've completed, their intake answers, the chart. The form comes back done — your team glances, signs, sends.

Received by fax
Jane Rivera
03/14/1972
62704
Lower back pain since 06/02 — worse sitting
06/02/2026
Your call — return-to-work date
07/11/2026
Mapped from every form she's ever filled
Mira filled 33 of 34 — one judgment call left for your team

How a fill works

01

Upload any image or PDF

Digital or scanned — Mira reads the layout, finds every fillable blank, and even titles and files the form for you. No template setup.

02

Mapped from everything on file

Every form this patient has ever completed becomes source material — intake answers, prior fills, the chart, uploaded documents. Mira maps it all onto the new form's blanks. The rare thing it can't source is flagged, never guessed.

03

Glance, sign, send

Usually there are one or two judgment calls left. Your saved signature drops in, and the finished PDF renders on the original form — ready for the carrier or employer.

$5 per completed form — billed only when you use it, with a ledger of every fill. No per-seat upsell, no module to license.

Teach it once. Adjust a box on a new form and Mira remembers the layout for every future fill of that form — the second Hartford packet opens ready to review.

FMLA Short-term disability Workers' comp CMS forms Return-to-work Insurance forms
Why Mira

Three ways to digitize intake. One was built for a clinic.

Generic builders look cheap until HIPAA — then they cost real money and still stop at the answer. Phreesia has real depth but enterprise weight. Only Mira carries the record across visits, verifies coverage, and writes back into your chart — light enough for a private practice.

Capability
Mira Private practice
Jotform
Typeform
Phreesia
Patient experience
Asks like a person, not a 90-field form
Returning patients confirm instead of re-typing
Record carries across practices
Speak answers instead of typing them
Smart & automated
Real-time insurance eligibility check
Reminders by text and email
Insurance-card photo capture
Save progress and finish later
Fills FMLA & disability PDFs from the chart
Fits your practice
Writes intake into your EHR
Rebuilds your paper forms from a PDF or photo
Beautiful PDFs that match your real forms
Light enough for a private practice (no rollout)
AI never trains on patient data
Full Partial None

vs. Jotform

A form builder where HIPAA alone runs about $200 a month — and it still just collects answers and stops. No eligibility, no reminders, nothing carries to the next visit.

vs. Typeform

The best-looking form on the market, and built for surveys, not clinics. No eligibility, no EHR, no record that follows the patient.

vs. Phreesia

Enterprise intake built for health systems, with the rollout and price to match. Mira gives a private practice the same depth — cheaper, lighter, and with payer-form filling Phreesia doesn't have.

Competitor capabilities reflect publicly available information and change over time; confirm current offerings with each vendor.

How It Works

A form that asks only what this visit needs.

No ninety static fields. The patient describes the problem in plain language, and Mira asks only the clinically pertinent follow-ups — along pathways your own providers author. Shorter for the patient, higher-signal for you.

Patient says

“My right knee gives out when I go down stairs.”

Right knee → instability path
  • Mechanism of injury & first onset
  • Locking, catching, or giving way
  • Prior knee surgery or imaging
  • Activity level & sport
  • KOOS-JR outcome measure
Never sees
  • Frozen-shoulder range-of-motion screen
  • Spine red-flag questionnaire
  • Hand & wrist grip assessment
  • Foot & ankle weight-bearing history
  • …and 70 other fields
Sports Medicine Hand & Upper Extremity Spine Total Joint Foot & Ankle Trauma Pediatric Ortho Shoulder & Elbow Workers' Comp

“My right shoulder has been aching since I fell skiing two weeks ago…”

Have you had any imaging yet — and does it ache at night?

Answer in your own words…

They talk, or type. Only the pertinent follow-ups come back.

And the moment they submit

Coverage

Insurance verified in real time

The card is captured and benefits checked the moment they submit — prior-auth and copay flagged days before the visit, while there's still time to act.

Your chart

Written into your EHR

Each answer lands in the right field of the record — no one re-types a thing — and prints as a clean PDF that matches the exact forms your clinic already uses.

Next time

Saved to their record

What they entered carries to the next visit — and across every practice on Mira — so next time they confirm what you know instead of starting over.

Setup

Your forms, rebuilt in an afternoon. Not a migration project.

Describe a form in a sentence and watch it build itself. Or photograph the paper form on your clipboard and Mira rebuilds it — same questions, same sections, now digital. There is no form-builder to learn.

Paper · PDF · photo
Describe it in a sentence Rebuild from a document Start from a template Build from scratch Brief an adaptive interview
Eligibility & Payments

Catch the denial before it happens.

Most rejected claims start at the front desk — a wrong member ID, an expired plan, a missed prior auth. Mira runs real-time eligibility and benefits the moment the patient submits, days before the visit, so your team fixes problems while there's still time to fix them.

A single manual eligibility check can take a staffer 10–15 minutes on the phone. Mira runs one for every patient automatically — and re-checks before the appointment.

On submit

Insurance card captured

The patient photographs their card; member ID, group, and payer fill in automatically — no squinting, no typos.

Minutes later

Coverage checked in real time

Eligibility and benefits run automatically — no staffer on hold with a payer to confirm a plan.

Before the visit

Auth & copay surfaced

Prior-authorization requirements flagged and the copay known while there’s still time to act on them.

Day of visit

Nothing to chase

The desk confirms a number instead of starting a claim it will have to rework later.

Mira Passport

Never ask the same question twice.

Most of the patients walking in today have been to your practice before. They shouldn't fill out the whole form again — and with Passport, they don't.

01

Confirm a code

A code by text or email verifies identity in seconds — no account, no password.

02

Their record loads

Demographics, insurance, medications, and history pre-filled from what they’ve already given.

03

Confirm or correct

They check what changed since last time, and move on.

Their record carries across visits — and across every practice on Mira. The longer you use Mira, the less intake there is to do.

And More

Everything else your front desk stops doing by hand.

Picture-perfect custom PDFs

Your real forms, rendered exactly — your logo, your layout, signatures and all. Surgery reservations, workers’ comp, clearance letters, referrals. Not a generic export.

Fewer no-shows

Reminders go out by text and email before the appointment, each with a one-tap link back to the exact form. Patients reply STOP any time.

Talk instead of type

Patients who’d rather speak just say their answers, and they land as structured fields — hands-free for the post-op patient in a sling.

Start now, finish later

Patients who can’t finish in one sitting pick up exactly where they left off from a link — so forms get completed, not abandoned.

Waiting-room kiosk

Hand a patient the clinic iPad and it wipes clean for the next one. Shared device, zero data bleed between patients.

Build a form by describing it

Tell Mira what you need — “new-patient rotator cuff intake” — and the form is built in seconds, the right fields and all. No form-builder to learn.

Surgery reservations that fill themselves

Pick the procedure and Mira proposes anesthesia, positioning, implants, and pre-op orders. Your team confirms instead of building each one from scratch.

Point to where it hurts

Patients mark the pain on a body diagram instead of describing it — localized and structured, straight into the chart.

Integration & Trust

Writes into your EMR. Never into a training set.

Intake data lands in the patient record automatically — no copy-paste, no double-entry — and every record is handled to clinical privacy standards.

Epic
Athena
ModMed
eClinicalWorks
Greenway
DrChrono
+ picture-perfect PDFs for any system

HIPAA + signed BAA

HIPAA-grade by design, backed by a signed Business Associate Agreement — not a paid checkbox.

Never trains on patient data

AI runs on a private, walled model. Patient data is never used to train models.

Encrypted, logged, and access-controlled

Patient data is encrypted end to end, and every staff view of a record is logged.

Get Started

Retire the clipboard. And the re-typing.

See what Mira takes off your front desk — patients who never re-enter what you already know, a dynamic form that asks only what each visit needs, real-time coverage, and a clean PDF into your EHR. Built for orthopedic private practice.