{
	"fillkite": 1,
	"exported": "2026-10-07T00:00:00+00:00",
	"forms": [
		{
			"title": "Patient intake",
			"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": "half"
					},
					{
						"id": "f_phone",
						"type": "phone",
						"label": "Phone",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "half"
					},
					{
						"id": "f_date_of_birth",
						"type": "date",
						"label": "Date of birth",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full"
					},
					{
						"id": "f_reason",
						"type": "select",
						"label": "Reason for your visit",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"options": [
							{
								"label": "Check-up",
								"value": "Check-up"
							},
							{
								"label": "New symptoms",
								"value": "New symptoms"
							},
							{
								"label": "Follow-up",
								"value": "Follow-up"
							},
							{
								"label": "Prescription refill",
								"value": "Prescription refill"
							},
							{
								"label": "Other",
								"value": "Other"
							}
						]
					},
					{
						"id": "f_symp",
						"type": "textarea",
						"label": "Describe your symptoms",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_reason",
									"operator": "is",
									"value": "New symptoms"
								}
							]
						}
					},
					{
						"id": "f_how_long_have_you_had_them",
						"type": "select",
						"label": "How long have you had them?",
						"placeholder": "",
						"helpText": "",
						"required": false,
						"width": "full",
						"options": [
							{
								"label": "Less than a week",
								"value": "Less than a week"
							},
							{
								"label": "1 to 4 weeks",
								"value": "1 to 4 weeks"
							},
							{
								"label": "More than a month",
								"value": "More than a month"
							}
						],
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_reason",
									"operator": "is",
									"value": "New symptoms"
								}
							]
						}
					},
					{
						"id": "f_which_medicine",
						"type": "text",
						"label": "Which medicine?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_reason",
									"operator": "is",
									"value": "Prescription refill"
								}
							]
						}
					},
					{
						"id": "f_alg",
						"type": "radio",
						"label": "Do you have any allergies?",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"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": true,
						"width": "full",
						"logic": {
							"action": "show",
							"match": "all",
							"rules": [
								{
									"field": "f_alg",
									"operator": "is",
									"value": "Yes"
								}
							]
						}
					},
					{
						"id": "f_consent",
						"type": "consent",
						"label": "Consent",
						"placeholder": "",
						"helpText": "",
						"required": true,
						"width": "full",
						"content": "I agree to the storing of my health details for my care."
					}
				],
				"submit": {
					"label": "Send my details",
					"align": "left"
				}
			},
			"settings": {
				"confirmation": {
					"type": "message",
					"message": "Thanks! We have your details and will confirm your visit.",
					"redirectUrl": "",
					"downloadUrl": "",
					"downloadLabel": ""
				}
			}
		}
	]
}