How to sign a fax and send it back without printing

Open the fax in your inbox, place your e-signature where the form asks for it, send it to the return number printed on the form and keep the delivery certificate: four steps, no printer and no scanner, on every Fax Pigeon plan from $4.99 a month billed annually. In a transaction in or affecting interstate or foreign commerce, federal law says a signature may not be denied legal effect solely because it is electronic (15 U.S.C. 7001(a)). HHS says a covered entity may act on a faxed copy of a signed HIPAA authorization (HHS).

Plans of care, orders, refill requests and releases are among the forms that arrive by fax and wait for a signature. Without a signing tool in the fax inbox, the routine is to print the page, sign it, scan it and fax it back. An online fax service that keeps a covered entity's faxes maintains protected health information for it, which makes the service a business associate (45 CFR 160.103). HIPAA lets a covered entity hand that information to a business associate only on satisfactory assurances documented in a written agreement (45 CFR 164.502(e)). Every Fax Pigeon plan includes a signed BAA, executed at signup.

What are the steps to sign and return a fax?

1. Open the fax in your inbox. If the form needs one clinician's signature, assign the fax to that clinician first, so the person named on the signature line is the one who opens it.
2. Sign where the form asks. Place your e-signature on the signature line. A form that asks for a signature on more than one page gets one on each.
3. Send it to the return number. Use the return fax number printed on the form, which can differ from the number the fax came from, and compare it digit by digit before you send. A wrong number is the main risk in faxing, and a signed form that reaches the wrong office is a disclosure you did not intend. The signed pages go out from your practice's own number.
4. Keep the delivery certificate. Fax Pigeon issues one for every delivered fax. File it with the request the form answers.

Does an electronic signature count on a faxed form?

The E-SIGN Act, HHS's HIPAA guidance and Medicare's review manual each speak to it. Each row links the text.

The form's own instructions still decide who must sign. Express Scripts' General Request Form, for one, carries a prescriber signature line, and the prescriber signs it even when someone else sends it.

Who signs when the whole practice shares the inbox?

Whoever the signature line names. Medicare's review manual says that even when two people are in the same group, one should not sign for the other in medical record entries or attestation statements. In a shared inbox, assign the fax to the clinician the form names and let that clinician sign it. Everyone in the practice signs in as themselves.

What does a signed HIPAA authorization need before it goes back?

The individual signs it: the patient, or a personal representative who adds a description of their authority to act. A valid authorization must contain at least six core elements (45 CFR 164.508(c)(1)): a specific description of the information, who may disclose it, who may receive it, each purpose, an expiration date or event, and the individual's signature and date. The form must also tell the individual of the right to revoke it in writing, whether treatment, payment, enrollment or eligibility can be conditioned on signing it, and that information released under it may be redisclosed by the recipient and lose the rule's protection.

An authorization that has not been filled out completely, with respect to a core element, is not valid (164.508(b)(2)), so the date matters as much as the signature. A covered entity that asks for an authorization must give the individual a copy of the signed form (164.508(c)(4)). It must also keep the signed form for six years from the date it was created or last in effect, whichever is later (164.508(b)(6) and 164.530(j)), and 164.530(j)(1)(ii) accepts an electronic copy. How psychologists fax evaluation reports shows a release in use.

Does signing cost extra?

Not at Fax Pigeon. E-signatures come with every plan, so a signed form costs only the pages it uses, counted with everything else sent and received that month. Basic is $4.99 a month billed annually ($5.99 month to month) for 200 pages, and Max is $159.99 billed annually for 10,000. The pricing page lists all six. Unlimited people share the inbox at no extra cost, so every clinician who signs has a login of their own.

Documo's Fax Signature page says its customers "pay only for the documents you send." Its pricing page prints no price for signing: neither the plan cards nor the side-by-side table, where Solo is $25 a month billed annually for 300 pages, lists it. Solo includes one user and charges $3.00 for each additional one.

* Prices last verified October 7, 2026, at each provider's own site. Fax Pigeon is not affiliated with Documo.