Skip to content

Dentist and clinics

Orthodontic consultation

A child’s form asks for a parent, and clear aligners open a question about teeth already moved. Free to use with FillKite.

Live demo

Orthodontic consultation

Fill it in and press the button to see how it behaves. Nothing you type is saved or sent.

Download this form
Try it in your browser

Test mode: you can try this form, but nothing you send is saved or passed on.

Patient name
Which option interests you?
Have you had braces before?

What is in this form

  • Patient name (required)
  • Patient age (required)
  • Parent or guardian name (required)
  • Email (required)
  • Phone
  • Which option interests you? (required)
  • Have you had braces before?
  • How many years ago?
  • What would you like to change?

How the conditional logic works

This form shows or hides fields as people answer, so everyone sees only what matters to them.

  • “Parent or guardian name” appears only when “Patient age” is less than “18”.
  • “How many years ago?” appears only when “Have you had braces before?” is “Yes”.
  • “What would you like to change?” appears only when “Which option interests you?” is “Not sure”.

Use it on your site

  1. Install FillKite free from WordPress.org.
  2. Download this form with the button above.
  3. Go to FillKite → Import → From a FillKite file, choose the file and import it.

Questions

About this form

Is the orthodontic consultation form free?

Yes. It works with the free FillKite plugin, and you can download it and change it as you like.

Is anything I type saved?

No. This demo runs in test mode: FillKite checks your answers like a real form, but nothing is saved and no email is sent.

How do I use this form on my site?

Install FillKite, download the form with the button on this page, then go to FillKite → Import → From a FillKite file and choose the file. After importing, open it in the builder, change anything you like and add it to a page.

Does this form use conditional logic?

Yes. 3 fields or notices show only when earlier answers call for it. “Parent or guardian name” appears only when “Patient age” is less than “18”.

What fields does it have?

It has 9 fields: Patient name, Patient age, Parent or guardian name, Email, Phone, Which option interests you?, Have you had braces before?, How many years ago? and more.

More dentist and clinics forms

Try another one.

Dental appointment

Conditional logic. A check-up asks when you last visited, and pain opens a question about how bad it is.

Try this form

Emergency dental request

Conditional logic. A broken tooth, swelling or bleeding each show the right advice, and swelling shows a warning.

Try this form

Teeth whitening enquiry

Conditional logic. Smokers and coffee drinkers get extra advice, and past sensitivity asks which kind.

Try this form

Free on WordPress.org

Build your first form in minutes.

Install FillKite free, import this form, and change it to fit your site.

Get FillKite free
All form demos