How can I give anyone access to a form via my website, have them sign it, and have it sent to me, without me having to request their signature via e-mail?

As a physician, I would like people to be able to access this form and have them sign it before they come and see me in my practice. The form is a release of information request form so that I may obtain their records from another facility, have reviewed them, and saved both of us time before we meet for our initial new patient visit.

Ideally, there would be a link on my website where they are able to access this form, sign it, and then it is e-mailed to me, signed. This way I can quickly obtain the pdf and fax it to the previous provider and request their records.

Thanks for the help and suggestions.