Skip to content

Fitness and beauty

Health questionnaire

Any "yes" answer shows a note to talk to a doctor first, with a text box for details. Free to use with FillKite.

Live demo

Health questionnaire

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.

Your name
Has a doctor said you have a heart condition?
Do you feel pain in your chest when you exercise?
Do you lose balance or feel dizzy?
Do you take medicine for blood pressure?

What is in this form

  • Your name (required)
  • Date of birth (required)
  • Has a doctor said you have a heart condition? (required)
  • Do you feel pain in your chest when you exercise? (required)
  • Do you lose balance or feel dizzy? (required)
  • Do you take medicine for blood pressure? (required)
  • Anything we should know?

How the conditional logic works

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

  • A notice appears only when “Has a doctor said you have a heart condition?” is “Yes” or “Do you feel pain in your chest when you exercise?” is “Yes” or “Do you lose balance or feel dizzy?” is “Yes” or “Do you take medicine for blood pressure?” is “Yes”.
  • “Anything we should know?” appears only when “Has a doctor said you have a heart condition?” is “Yes” or “Do you feel pain in your chest when you exercise?” is “Yes” or “Do you lose balance or feel dizzy?” is “Yes” or “Do you take medicine for blood pressure?” is “Yes”.

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 health questionnaire 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. 2 fields or notices show only when earlier answers call for it. A notice appears only when “Has a doctor said you have a heart condition?” is “Yes” or “Do you feel pain in your chest when you exercise?” is “Yes” or “Do you lose balance or feel dizzy?” is “Yes” or “Do you take medicine for blood pressure?” is “Yes”.

What fields does it have?

It has 7 fields: Your name, Date of birth, Has a doctor said you have a heart condition?, Do you feel pain in your chest when you exercise?, Do you lose balance or feel dizzy?, Do you take medicine for blood pressure?, Anything we should know?.

More fitness and beauty forms

Try another one.

Gym membership

Conditional logic. Plan-specific add-ons, injuries, a student discount and direct debit details each appear only when needed.

Try this form

Personal trainer booking

Conditional logic. Rehab goals ask for medical clearance, and no clearance shows a notice.

Try this form

Salon appointment

Conditional logic. Colour asks about recent colouring, bridal asks for the wedding date, and allergies open a box.

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