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Form demos

Patient intake form

A patient intake form that asks follow-up questions only when they matter: symptoms for a new problem, a medicine name for a refill. Try it, then see the other health forms.

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Patient intake

The questions change with the reason for the visit: symptoms for a new problem, a medicine name for a refill.

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

Your name
Do you have any allergies?

All 6 forms

More forms in this category.

Every one is a working demo. 6 use conditional logic and 1 need FillKite Pro.

Patient intake

Conditional logic. The questions change with the reason for the visit: symptoms for a new problem, a medicine name for a refill.

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Doctor appointment by department

Conditional logic. Each department asks its own question, and an urgent warning appears for chest pain.

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Vaccination booking

Conditional logic. Questions about pregnancy and earlier doses appear only for the people they apply to.

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Insurance details

Conditional logic. Insurance fields show only if the patient is insured, and policyholder fields only if it is someone else.

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Counselling intake

Conditional logic. Follow-ups depend on earlier answers, and a crisis warning shows when someone says they need help now.

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Patient registration with signature

PRO · Multi-step, File upload, Signature · Conditional logic. Three steps: details, medical history, then an ID upload and a signature on the consent.

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How it works

From this page to your site in three steps.

  1. Install FillKite

    It is free. In your WordPress admin go to Plugins → Add New, search for FillKite and press Install Now.

  2. Download the form

    Every demo has a Download button. You get a small .json file.

  3. Import it

    In WordPress go to FillKite → Import → From a FillKite file, choose the file, and import. Change anything you like, then publish.

More form types

Looking for something else?

Education and schools

Courses, scholarships, school trips and parent meetings, with questions that adapt.

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Real estate and property

Buying, renting, viewings and repairs, each with the right follow-up questions.

Try the demos

Restaurants and food

Tables, catering, takeaway and food trucks, with follow-up questions.

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Questions

About these patient intake form demos

Which forms are in this category?

There are 6: Patient intake, Doctor appointment by department, Vaccination booking, Insurance details, Counselling intake, Patient registration with signature.

Are these forms free?

5 of the 6 work with the free FillKite plugin. The other 1 are tagged PRO and use FillKite Pro; you can still try them here.

Do they use conditional logic?

6 of the 6 show or hide fields depending on earlier answers. Each form page explains its rules.

Is anything I type saved?

No. Demo forms run in test mode, so nothing is saved and no email is sent.

How do I use one 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.

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