Custom Form Guide

Wendi's custom form builder can collect and save any information from a patient or lead -- the only limit is your imagination!

Table of Contents

• How the Custom Form Builder Works

• Available Field Types

  • Select Input
  • Checkbox
  • Text Area
  • MultiSelect
  • Issues Picker
  • Display Text
  • Phone Number
  • Email
  • Date of Birth
  • Legal Sex
  • Payment Methods
  • Hidden Field
  • First and Last Name
  • Signature Pad
  • Date

  • Insurance

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The custom form builder is available through the "Forms" link on the left navigation. Here you can build a custom form with a title, description, and a variety of fields.

The custom from builder's form editor, live preview, and add new field button

 

The custom form builder has a live preview that updates as you type. This preview displays what the lead or patient will see when they interact with the form using Wendi.

 

To add new fields to the form, use the plus button at the bottom of the form editor. Fields can also be removed, duplicated, and marked as required. When you add a new field to a custom form using the custom form builder, select the Input Type using the dropdown.

This screenshot highlights the Input Type dropdown

 

There are a variety of different form inputs available. You can add as many inputs as you'd like. Some inputs will save their data to the patient or lead completing the form. These are marked with an asterisk (*):

Select Input

This will display a drop-down with the options you provide. Only one options is can be selected.

Checkbox

A checkbox representing a true or false question.

Text Area

A place to solicit a paragraph long block of text.

MultiSelect

A drop-down where multiple options can be selected.

Issues Picker

Provides a multiselect list of the issues specified in your match criteria.

Display Text

A place to show static text, such as instructions a legal disclaimer.

Phone Number*

Form input for a formatted phone number.

Email*

Form input for a formatted email.

Date of Birth*

Form input for a birth date.

Legal Sex*

Form input for legal sex. 

Payment Methods

Drop-down single select options for different payment methods. This field is also on the standard inquiry form.

Hidden Field

A hidden field to store data from cookies, local storage, or session storage. You can add as many as you need.

First and Last Name*

Fields for capturing the first and last name of the person filling out the form.

Signature Pad

An area to collect e-signatures.

Date

A date selected from a calendar.

Insurance*

The insurance input type will display the available payers, along with a field to collect Member ID. It is the same as the insurance company input on the standard Benefits Form.

 

 

* Indicates this field will save to the patient or lead filling out the custom form.