Letters and e-signature
Letters and signed consent, without a printer or a scanner
Attendance notes, treatment summaries, letters of medical necessity, referrals and consent forms, written on your letterhead, locked once signed, and signed by the patient from wherever they are.
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Fewer scattered Word files, fewer scans
A letter to or about a patient is usually typed in a separate file, printed, signed, scanned and saved somewhere. Here it is written inside Zento from the patient's record, locked when it is ready, and when the patient needs to sign, they sign remotely and the signed copy comes back to their card.
What you can write
A complete letter, from draft to PDF
Seven kinds of letter
Attendance note, treatment summary, letter of medical necessity, referral, informed consent, treatment agreement, and a blank letter for anything else.
Filled in from the record
Each clinical letter fills in what it needs from your signed notes: the visit date for an attendance note; the first and last visits, visit count and diagnoses for a treatment summary; the diagnoses with ICD-10 codes for a medical necessity letter or a referral.
Gaps you cannot miss
The parts only you can write are marked in double brackets. A button takes you to the next one, and the letter cannot be signed while any are left.
Signed and locked
Once you sign, the letter is numbered for your practice and fingerprinted with SHA-256. It cannot be changed or deleted, and the fingerprint is checked again before the PDF is produced.
A PDF on your letterhead
Your practice name, address and phone at the top, and your name, license and NPI under the signature.
Remote signature
Informed consent and treatment agreements go to the patient to sign by email, or as a link you share yourself.
How it works
Three steps to a finished letter
Choose the kind of letter
From the patient's card, pick one of the seven kinds. A clinical letter starts as a draft filled in from their signed notes, and for an attendance note you choose the visit.
Write what only you can
The draft is plain text, ready to edit, with the gaps marked.
- Patient and practice names filled in
- The visit date, visit count or ICD-10 diagnoses, as the kind of letter needs
- Gaps in double brackets, and a button to jump to the next
- Your letterhead and credentials added to the PDF
Sign and lock
When it is ready, sign it. From that moment it is numbered, fingerprinted and locked. Download the PDF, or send a consent form or agreement for the patient's signature.
Remote signature
The patient signs remotely, and the copy comes back to their card
A consent form or treatment agreement does not have to wait for the next visit. Send a link, and the patient signs from their phone or computer.
Send a link
By email from Zento, or copy the link and share it yourself. It stays open for 14 days.
Confirm with a code
A six-digit code goes to the email on the patient's card. Until it is entered, even the document's title stays hidden.
Sign
By typing their name or drawing a signature, as the patient, a parent or guardian, or a legal representative.
Back on the card
The signed PDF is saved and locked under Letters on the patient's card, where the request shows who signed it.
Signature evidence
Every signature keeps its context
A signature on its own does not say who signed, when, or what. So with each one, Zento keeps:
- The signer's name, role and signing method
- When the one-time code was verified, and the masked email it went to
- The signing time, IP address and device
- The letter's SHA-256 fingerprint
- The exact consent wording the signer saw
- The signed PDF's own SHA-256 fingerprint
The evidence is stored encrypted. A certificate page with the signer, the code check, the time, IP address and device, and the letter's fingerprint is added to the end of the signed PDF, and the PDF itself is locked: it cannot be changed or deleted.
One letter, from the template to the patient's card
Step 1 of 6
Start from the kind of letter
Pick the patient and one of the seven kinds. The two the patient signs are marked.
All names and details in these illustrations are made up. None of it belongs to a real patient.
Letters and e-signature by plan
Frequently asked questions
Which letters can I write?
Attendance notes, treatment summaries, letters of medical necessity, referrals, informed consent, treatment agreements and a blank letter on your letterhead. Each kind starts from its own draft: an attendance note with the visit date, a treatment summary with the first and last visits, the visit count and the diagnoses, a medical necessity letter or referral with the diagnoses and their ICD-10 codes, and consent forms and agreements with ready-written wording. The blank letter starts empty.
Can I change a letter after signing it?
No. A signed letter is numbered, fingerprinted with SHA-256 and locked: it cannot be changed or deleted. If something needs to be different, write a new letter. That way it is always clear exactly what was sent or signed.
Which letters can the patient sign?
Informed consent and treatment agreements. The other kinds are letters you sign and send.
How does the patient sign?
They get a link by email, or one you share yourself. They enter a six-digit code sent to the email address on their file, agree to sign electronically, and sign by typing their name or drawing a signature. They can download a copy straight after signing.
What does the patient agree to before signing?
They see a disclosure covering the paper alternative, how to withdraw consent and how to get a copy, and must tick both "I agree to sign electronically" and "I have read this document and agree to it". The wording they saw is stored with the signature.
What is kept as evidence?
The signer's name, method and role, the masked email the code went to and when it was verified, the signing time, IP address and device, the letter's fingerprint and the consent wording shown. It is stored encrypted, and summarized on a certificate page at the end of the signed PDF.
Where is the signed copy kept?
On the patient's card, under Letters, as a signed PDF beside the request. It is stored encrypted, checked against its fingerprint when it is downloaded, and cannot be changed or deleted.
Which plans include it?
Every plan: Starter, Growth and Pro.
More features that work together
Each feature is useful on its own. The real value comes when they connect: a profile that brings patients in, inquiries that become appointments, and appointments that bring reviews.
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One page that shows your practice, your training and how you work.
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Digital presence
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Reviews and trust
Verified reviews from people who confirmed their email.
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Inquiries in one place
Every message that comes in, tracked, so none of them is missed.
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Online booking
Clients pick a time that is genuinely free and book it themselves.
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Automatic reminders
Reminders go out before every appointment without you sending them.
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Client records
Everyone you see, their history and their notes, in one place.
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Patient file
Signed visit notes, treatment goals, documents, patient details and a timeline in one encrypted file, with an access log and a PDF export of the file.
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Outcome measures
Send PHQ-9, PHQ-8, GAD-7 or PEG by link. The patient answers on their phone, the score is calculated as published, and the trend sits in their file.
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Superbills and reports
Superbills from signed notes, a monthly financial summary, a treatment log, and card payments into your own Stripe account.
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Security and privacy
Two-step verification, control over logged-in devices, automatic logout, lockout after failed attempts, and record-level encryption of clinical records.
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The practitioner app
Install your dashboard on your phone, tablet or computer from the dashboard itself, with no app store, and subscribe to your appointments from the calendar you already use.
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A letter that is written, locked and signed, without a printer or a scanner
Start a 21-day trial and write your first letter from a patient's signed notes.
21 days free on Growth and Pro · cancel any time