Healthcare and wellness

Doctor appointment by department

Each department asks its own question, and an urgent warning appears for chest pain. Free to use with FillKite.

Live demo

Doctor appointment by department

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

What is in this form

Your name (required)
Phone (required)
Department (required)
Child’s age (required)
Where is the skin problem?
Do you have chest pain right now? (required)
Preferred date (required)

How the conditional logic works

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

“Child’s age” appears only when “Department” is “Paediatrics”.
“Where is the skin problem?” appears only when “Department” is “Dermatology”.
“Do you have chest pain right now?” appears only when “Department” is “Cardiology”.
A notice appears only when “Do you have chest pain right now?” is “Yes”.

Use it on your site

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

Questions

About this form

Is the doctor appointment by department 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. 4 fields or notices show only when earlier answers call for it. “Child’s age” appears only when “Department” is “Paediatrics”.

What fields does it have?

It has 7 fields: Your name, Phone, Department, Child’s age, Where is the skin problem?, Do you have chest pain right now?, Preferred date.

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