Government and local services

Pothole report

A dangerous pothole shows an urgent notice, and wanting an update opens contact details. Free to use with FillKite.

Live demo

Pothole report

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

What is in this form

Street name (required)
Nearest house number or landmark
How big is it? (required)
Is it on… (required)
Would you like updates? (required)
Your name (required)
Email (required)

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 “How big is it?” is “Large” and “Is it on…” is “A road”.
“Your name” appears only when “Would you like updates?” is “Yes”.
“Email” appears only when “Would you like updates?” 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 pothole report 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. A notice appears only when “How big is it?” is “Large” and “Is it on…” is “A road”.

What fields does it have?

It has 7 fields: Street name, Nearest house number or landmark, How big is it?, Is it on…, Would you like updates?, Your name, Email.

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Free on WordPress.org

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