Clinic Appointment Request — shared by the community
Rachel O. shared this 16-question build with 3 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 16 questions, 2 pages, 3 conditional rules.
- Shared by
- Rachel O. · Events coordinator
- Questions
- 16
- Replies
- 23
- Copies taken
- 792
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Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
Page 1 of 2 — Who and what
Every question on this page is currently visible.
Works for you? Take Rachel O.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Clinic Appointment Request is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 16 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It captures a phone number for urgent follow-up.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Clinic Appointment Request lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 3 conditional rules ship with it.
- Features conditional validation: if “How soon do you need to be seen?” is As soon as possible, “Why sooner is important” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Appointment type” is Video appointment, the form dynamically exposes “Device you will join on”. Otherwise that question never appears.
- Features conditional validation: if “Do you want a particular clinician?” is Yes, “Which clinician?” becomes mandatory before the form can be sent.
- All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — Who and what
- Patient full namerequired
- Date of birthrequired
- Contact numberrequired
- Email addressrequired
- What is the appointment for?required
- How long has it been going on?required
- Is the patient already registered here?required
Page 2 — When and how
- How soon do you need to be seen?required
- Why sooner is important
- Appointment typerequired
- Device you will join on
- Do you want a particular clinician?required
- Which clinician?
- Days that workrequired
- Times that workrequired
- Times to avoid
Conditional logic in this build
- When “How soon do you need to be seen?” is As soon as possible, require “Why sooner is important”.
- When “Appointment type” is Video appointment, show “Device you will join on”.
- When “Do you want a particular clinician?” is Yes, require “Which clinician?”.
Questions about this shared form
Does this book the appointment automatically?
No. It produces a request with enough detail to be answered once. Automatic booking needs an open diary, which most clinics deliberately avoid for first appointments.
How is it different from the Telehealth Appointment Request?
That form is built around remote consultations, including the technical and location questions those need. This one covers both types and is the general front door for the diary.
Can we use it for follow-ups too?
Yes, though follow-ups are usually quicker to book from the room. Where a patient asks later, the same form works because the reason field carries the context.
What if the patient is not registered?
Send them the Quick Patient Registration first; the answer to the registration question is there so those requests can be spotted before a slot is offered.
Is the Clinic Appointment Request template free to use?
Yes. You can preview and test Clinic Appointment Request on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Clinic Appointment Request template ask for?
It asks 16 questions across 2 pages, 12 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Clinic Appointment Request form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
3 conditional rules ship with the template: Features conditional validation: if “How soon do you need to be seen?” is As soon as possible, “Why sooner is important” becomes mandatory before the form can be sent. Features advanced show logic: if “Appointment type” is Video appointment, the form dynamically exposes “Device you will join on”. Otherwise that question never appears. Features conditional validation: if “Do you want a particular clinician?” is Yes, “Which clinician?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Clinic Appointment Request form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Clinic Appointment Request form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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