{
	"fillkite": 1,
	"exported": "2026-10-07T00:00:00+00:00",
	"forms": [
		{
			"title": "Insurance details",
			"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_ins",
						"type": "radio",
						"label": "Do you have health insurance?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"options": [
							{
								"label": "Yes",
								"value": "Yes"
							},
							{
								"label": "No",
								"value": "No"
							}
						]
					},
					{
						"id": "f_insurance_company",
						"type": "text",
						"label": "Insurance company",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_ins",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					},
					{
						"id": "f_policy_number",
						"type": "text",
						"label": "Policy number",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_ins",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					},
					{
						"id": "f_holder",
						"type": "radio",
						"label": "Who holds the policy?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"options": [
							{
								"label": "Me",
								"value": "Me"
							},
							{
								"label": "Someone else",
								"value": "Someone else"
							}
						],
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_ins",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					},
					{
						"id": "f_policyholder_s_name",
						"type": "text",
						"label": "Policyholder’s name",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_ins",
									"operator": "is",
									"value": "Yes"
								},
								{
									"field": "f_holder",
									"operator": "is",
									"value": "Someone else"
								}
							]
						}
					},
					{
						"id": "f_how_would_you_like_to_pay",
						"type": "radio",
						"label": "How would you like to pay?",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"options": [
							{
								"label": "Pay in full",
								"value": "Pay in full"
							},
							{
								"label": "Payment plan",
								"value": "Payment plan"
							}
						],
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_ins",
									"operator": "is",
									"value": "No"
								}
							]
						}
					}
				],
				"submit": {
					"label": "Send insurance details",
					"align": "left"
				}
			},
			"settings": {
				"confirmation": {
					"type": "message",
					"message": "Thanks! We will check your cover before the visit.",
					"redirectUrl": "",
					"downloadUrl": "",
					"downloadLabel": ""
				}
			}
		}
	]
}