{
	"fillkite": 1,
	"exported": "2026-10-07T00:00:00+00:00",
	"forms": [
		{
			"title": "Dental history in steps",
			"status": "published",
			"schema": {
				"schemaVersion": 1,
				"fields": [
					{
						"id": "f_your_name",
						"type": "name",
						"label": "Your name",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full"
					},
					{
						"id": "f_email",
						"type": "email",
						"label": "Email",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full"
					},
					{
						"id": "f_date_of_birth",
						"type": "date",
						"label": "Date of birth",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full"
					},
					{
						"id": "f_step_your_teeth",
						"type": "page_break",
						"label": "Your teeth",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"nextLabel": "",
						"backLabel": ""
					},
					{
						"id": "f_sym",
						"type": "checkbox",
						"label": "Do you have…",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"options": [
							{
								"label": "Bleeding gums",
								"value": "Bleeding gums"
							},
							{
								"label": "Bad breath",
								"value": "Bad breath"
							},
							{
								"label": "Grinding at night",
								"value": "Grinding at night"
							},
							{
								"label": "A dry mouth",
								"value": "A dry mouth"
							}
						]
					},
					{
						"id": "f_how_often_do_you_brush",
						"type": "radio",
						"label": "How often do you brush?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"options": [
							{
								"label": "Once a day",
								"value": "Once a day"
							},
							{
								"label": "Twice a day",
								"value": "Twice a day"
							},
							{
								"label": "More",
								"value": "More"
							}
						]
					},
					{
						"id": "f_do_you_floss",
						"type": "radio",
						"label": "Do you floss?",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"options": [
							{
								"label": "Daily",
								"value": "Daily"
							},
							{
								"label": "Sometimes",
								"value": "Sometimes"
							},
							{
								"label": "Never",
								"value": "Never"
							}
						]
					},
					{
						"id": "f_step_your_health",
						"type": "page_break",
						"label": "Your health",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"nextLabel": "",
						"backLabel": ""
					},
					{
						"id": "f_med",
						"type": "radio",
						"label": "Do you take regular medication?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"options": [
							{
								"label": "Yes",
								"value": "Yes"
							},
							{
								"label": "No",
								"value": "No"
							}
						]
					},
					{
						"id": "f_which_medication",
						"type": "textarea",
						"label": "Which medication?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_med",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					},
					{
						"id": "f_all",
						"type": "radio",
						"label": "Any allergies?",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"options": [
							{
								"label": "Yes",
								"value": "Yes"
							},
							{
								"label": "No",
								"value": "No"
							}
						]
					},
					{
						"id": "f_what_are_you_allergic_to",
						"type": "text",
						"label": "What are you allergic to?",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_all",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					}
				],
				"submit": {
					"label": "Send my history",
					"align": "left"
				}
			},
			"settings": {
				"confirmation": {
					"type": "message",
					"message": "Thanks! Your dentist will read this before you arrive.",
					"redirectUrl": "",
					"downloadUrl": "",
					"downloadLabel": ""
				},
				"multiStep": {
					"progress": "steps",
					"firstTitle": "About you"
				}
			}
		}
	]
}