HelloForms
Fitness, Wellness & Coaching · community shared

Dental Registration Form — shared by the community

Sam B. shared this 16-question build with 3 conditional rules already wired up. Test it below, then take a copy.

A ready-to-use fitness, wellness & coaching form for clinics, coaches and therapists: 16 questions, 3 pages, 3 conditional rules.

Shared by
Sam B. · Customer success
Questions
16
Replies
16
Copies taken
137
See the library version

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Live preview and test console

This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.

Page 1 of 3 — Your details

New dental patient registration

Include your country code.

Every question on this page is currently visible.

Works for you? Take Sam B.'s copy into your own workspace — questions, rules and settings included.

Who this template is for

Dental Registration Form is built for clinics, coaches and therapists who need to collect intake detail and consent before the first session.

  • Clinics, coaches and therapists working in fitness, wellness & coaching.
  • Teams who need to collect intake detail and consent before the first session without writing code or paying for a custom build.
  • Anyone replacing paperwork eating the start of every appointment with one structured record per enquiry.
  • Respondents are clients and patients — the form asks them 16 questions across 3 screens.
  • Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of paperwork eating the start of every appointment and turns each submission into a record your team can act on immediately.

  • 8 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 records a signature you can keep as proof of agreement.
  • It pins the request to a specific date.
  • It captures a full postal address.
  • It allows multiple selections without free text.
  • Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

  1. 1Press “Use this template” — a fresh copy of Dental Registration Form lands in your workspace, ready to edit.
  2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
  3. 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.
  4. 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.
  5. 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 will you be paying?” is Dental insurance, “Insurance provider” becomes mandatory before the form can be sent.
  • Features advanced show logic: if “How will you be paying?” is Dental insurance, the form dynamically exposes “Member / policy number”. Otherwise that question never appears.
  • Features advanced show logic: if “Do you grind or clench your teeth?” is Yes, the form dynamically exposes “Do you currently wear a night guard?”. Otherwise that question never appears.
  • 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 — Your details

  • Full namerequired
  • Date of birthrequired
  • Email addressrequired
  • Phone number
  • Home address
  • Emergency contact name and phone numberrequired

Page 2 — Dental & insurance

  • Date of your last dental visit
  • Reason for today's visitrequired
  • Do you grind or clench your teeth?
  • Do you currently wear a night guard?
  • Do any of these apply to you?
  • How will you be paying?required
  • Insurance provider
  • Member / policy number

Page 3 — Consent

  • Agreementrequired
  • Patient or guardian signaturerequired

Conditional logic in this build

  • When “How will you be paying?” is Dental insurance, require “Insurance provider”.
  • When “How will you be paying?” is Dental insurance, show “Member / policy number”.
  • When “Do you grind or clench your teeth?” is Yes, show “Do you currently wear a night guard?”.

Questions about this shared form

How is this different from the Patient Registration Form?

Patient Registration Form is written for a general medical practice and asks broader insurance and history questions. This form is dental-specific — it asks about grinding, night guards and last dental visit instead.

Should I still use the Medical History Form?

For patients with more complex health backgrounds, yes — pair this form with the Medical History Form rather than trying to fit everything into one dental intake.

Does the consent section replace my practice's own paperwork?

No, it's a general acknowledgement only. Anything beyond a routine exam should still go through your practice's own reviewed consent process.

Can I use this for an existing patient's annual update?

Yes, just shorten it to the dental-history and insurance sections since contact details are likely already on file.

Is the Dental Registration Form template free to use?

Yes. You can preview and test Dental Registration Form 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 Dental Registration Form template ask for?

It asks 16 questions across 3 pages, 8 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 Dental Registration Form 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 fitness, wellness & coaching form work?

3 conditional rules ship with the template: Features conditional validation: if “How will you be paying?” is Dental insurance, “Insurance provider” becomes mandatory before the form can be sent. Features advanced show logic: if “How will you be paying?” is Dental insurance, the form dynamically exposes “Member / policy number”. Otherwise that question never appears. Features advanced show logic: if “Do you grind or clench your teeth?” is Yes, the form dynamically exposes “Do you currently wear a night guard?”. Otherwise that question never appears. All rules are editable in the Logic tab.

Where do responses to the Dental Registration Form 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 Dental Registration Form 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.

Is the signature on this form legally usable?

The template captures a drawn signature and stores it with the submission, along with the timestamp, so you keep evidence of who agreed and when. Whether that is sufficient depends on your jurisdiction and the agreement itself.

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