Field types
What can your form do?
Here are the fields we build most often, from a simple name box to a tap-to-select body map. Don't see what your paper form needs? Just ask, and we'll look into it.
Catch common mistakes before they reach your front desk.
Mark a question as required and the form can't be sent until it's answered. Your desk won't receive forms with those questions left blank.
Shorter forms that are quicker to fill in.
Show and hide questions is available on every form; each conditional question counts as 1 point (see pricing)
Phone numbers, dates and Medicare numbers are checked for the right format when the form is sent. We check the format only. We don't check a number with Medicare, a health fund or anyone else.
A second email box helps catch typos, so reminders and copies are more likely to reach the right inbox.
Typed answers, not handwriting.
No more squinting at a scrawled phone number.
Every submission is stored with the date and time it came in and, if your form has a consent tick, the answer given.
Everyday fields
Short and long text
Answers from a name to a longer note
- Handy for:
- Everyone
Full name
First and last name, with an optional title (Mr, Ms, Dr)
- Handy for:
- Everyone
- See it in:
- New patient demo, Clinic intake demo, GEN-001, DEN-001, PHY-001, GEN-004, GEN-005, FIT-001, BEA-001, TRD-001
Email
Checks the email address is in the right format
- Handy for:
- Everyone
Phone and mobile
10-digit mobile number format, e.g. 0491 570 006
- Handy for:
- Everyone
- See it in:
- New patient demo, GEN-001, DEN-001, GEN-005, TRD-001
Date and date of birth
Date picker with limits (e.g. no future birth dates), plus age worked out for you
- Handy for:
- Clinics, schools, gyms
- See it in:
- New patient demo, Clinic intake demo, GEN-001, DEN-001, PHY-001, FIT-001, BEA-001
Date range
Start and end dates in one field
- Handy for:
- Hospitality, HR, hire
- See it in:
- Ask us for an example
Time
Time of day or a duration
- Handy for:
- Trades, events, clinics
- See it in:
- GEN-005
Number
Numbers with a minimum and maximum
- Handy for:
- Everyone
- See it in:
- Ask us for an example
Dropdown
Pick one from a list, including linked lists
- Handy for:
- Everyone
- See it in:
- Ask us for an example
Multi-select list
Pick several from a long list
- Handy for:
- Clinics, retail
- See it in:
- Ask us for an example
Single choice
Pick one option
- Handy for:
- Everyone
Checkboxes
Tick all that apply
- Handy for:
- Everyone
- See it in:
- Clinic intake demo, GEN-001, DEN-002
Picture choices
Choose by tapping a picture
- Handy for:
- Cosmetics, retail, hospitality, kids' forms
- See it in:
- Ask us for an example
Address
Street, suburb, state and postcode
- Handy for:
- Everyone
- See it in:
- TRD-001
Height and weight
Switch between metric and imperial
- Handy for:
- Clinics, fitness
- See it in:
- Ask us for an example
| Field | What it does | Handy for | See it in |
|---|---|---|---|
| Short and long text | Answers from a name to a longer note | Everyone | Clinic intake demo, GEN-001, GEN-003, DEN-001, DEN-002, PHY-001, GEN-004, GEN-005, BEA-001, TRD-001 |
| Full name | First and last name, with an optional title (Mr, Ms, Dr) | Everyone | New patient demo, Clinic intake demo, GEN-001, DEN-001, PHY-001, GEN-004, GEN-005, FIT-001, BEA-001, TRD-001 |
| Checks the email address is in the right format | Everyone | New patient demo, GEN-001, DEN-001, GEN-004, GEN-005, TRD-001 | |
| Phone and mobile | 10-digit mobile number format, e.g. 0491 570 006 | Everyone | New patient demo, GEN-001, DEN-001, GEN-005, TRD-001 |
| Date and date of birth | Date picker with limits (e.g. no future birth dates), plus age worked out for you | Clinics, schools, gyms | New patient demo, Clinic intake demo, GEN-001, DEN-001, PHY-001, FIT-001, BEA-001 |
| Date range | Start and end dates in one field | Hospitality, HR, hire | Ask us for an example |
| Time | Time of day or a duration | Trades, events, clinics | GEN-005 |
| Number | Numbers with a minimum and maximum | Everyone | Ask us for an example |
| Dropdown | Pick one from a list, including linked lists | Everyone | Ask us for an example |
| Multi-select list | Pick several from a long list | Clinics, retail | Ask us for an example |
| Single choice | Pick one option | Everyone | DEN-002, FIT-001, BEA-001 |
| Checkboxes | Tick all that apply | Everyone | Clinic intake demo, GEN-001, DEN-002 |
| Picture choices | Choose by tapping a picture | Cosmetics, retail, hospitality, kids' forms | Ask us for an example |
| Address | Street, suburb, state and postcode | Everyone | TRD-001 |
| Height and weight | Switch between metric and imperial | Clinics, fitness | Ask us for an example |
Health and ID numbers (Australia)
Medicare and NDIS numbers are checked for the right number of digits when the form is sent. DVA numbers are checked for the right format. None of them are checked with Medicare, DVA, the NDIS or a health fund.
Medicare card
Card number, reference number (IRN) and expiry
- Handy for:
- GPs, allied health, dental, pathology
- See it in:
- Ask us for an example
DVA card
File number and card colour (Gold, White or Orange)
- Handy for:
- GPs, allied health, dental
- See it in:
- Ask us for an example
Private health insurance
Fund, membership number and level of cover
- Handy for:
- Dental, physio, chiro, optical
- See it in:
- New patient demo, DEN-001
Concession or healthcare card
Card number and expiry
- Handy for:
- Clinics, councils, community services
- See it in:
- Ask us for an example
NDIS
Participant number and plan manager details
- Handy for:
- Allied health, disability services
- See it in:
- Ask us for an example
Workers' comp or CTP claim
Claim number, insurer, employer and case manager
- Handy for:
- Physio, GPs, occupational rehab
- See it in:
- Ask us for an example
| Field | What it collects | Handy for | See it in |
|---|---|---|---|
| Medicare card | Card number, reference number (IRN) and expiry | GPs, allied health, dental, pathology | Ask us for an example |
| DVA card | File number and card colour (Gold, White or Orange) | GPs, allied health, dental | Ask us for an example |
| Private health insurance | Fund, membership number and level of cover | Dental, physio, chiro, optical | New patient demo, DEN-001 |
| Concession or healthcare card | Card number and expiry | Clinics, councils, community services | Ask us for an example |
| NDIS | Participant number and plan manager details | Allied health, disability services | Ask us for an example |
| Workers' comp or CTP claim | Claim number, insurer, employer and case manager | Physio, GPs, occupational rehab | Ask us for an example |
Signatures and consent
E-signature
Sign on the screen with a finger or mouse. The signature is included with the completed form
- Handy for:
- Everyone
- See it in:
- New patient demo, Clinic intake demo, GEN-001, GEN-002, GEN-003, DEN-001, DEN-002, PHY-001, FIT-001, BEA-001
Consent tick
A required "I agree" tickbox, with your terms shown or linked
- Handy for:
- Everyone
- See it in:
- Clinic intake demo, GEN-002, GEN-003, PHY-001, BEA-001
Initials per section
Initial each part of a consent form
- Handy for:
- Cosmetics, clinics, hire
- See it in:
- Ask us for an example
Parent or guardian section
Asks for a parent or guardian's details and e-signature when the person is under 18
- Handy for:
- Clinics, schools, sport, activities
- See it in:
- Ask us for an example
| Field | What it does | Handy for | See it in |
|---|---|---|---|
| E-signature | Sign on the screen with a finger or mouse. The signature is included with the completed form | Everyone | New patient demo, Clinic intake demo, GEN-001, GEN-002, GEN-003, DEN-001, DEN-002, PHY-001, FIT-001, BEA-001 |
| Consent tick | A required "I agree" tickbox, with your terms shown or linked | Everyone | Clinic intake demo, GEN-002, GEN-003, PHY-001, BEA-001 |
| Initials per section | Initial each part of a consent form | Cosmetics, clinics, hire | Ask us for an example |
| Parent or guardian section | Asks for a parent or guardian's details and e-signature when the person is under 18 | Clinics, schools, sport, activities | Ask us for an example |
Whether an e-signature suits a particular form is your call. We don't give legal advice, so check with your insurer, professional body or adviser if you're unsure.
Uploads and photos
File upload
Attach referrals, scans or PDFs
- Handy for:
- Everyone
- See it in:
- Clinic intake demo
Take a photo
Use the phone's camera inside the form
- Handy for:
- Clinics, trades, insurance
- See it in:
- Ask us for an example
| Field | What it does | Handy for | See it in |
|---|---|---|---|
| File upload | Attach referrals, scans or PDFs | Everyone | Clinic intake demo |
| Take a photo | Use the phone's camera inside the form | Clinics, trades, insurance | Ask us for an example |
Smart form behaviour
Show and hide questions
Questions appear or skip based on earlier answers
- Handy for:
- Everyone
- See it in:
- Ask us for an example
Calculations
Totals and scores worked out automatically (e.g. BMI, quotes)
- Handy for:
- Clinics, trades, retail
- See it in:
- Ask us for an example
Grids
A set of questions with the same answer options
- Handy for:
- Clinics, surveys, HR
- See it in:
- Ask us for an example
Repeating rows
"Add another" for medications, dependants or items
- Handy for:
- Clinics, insurance, orders
- See it in:
- Ask us for an example
Multi-page forms
Long forms split into steps
- Handy for:
- Everyone
- See it in:
- Ask us for an example
Reference number
A reference code on each submission
- Handy for:
- Everyone
- See it in:
- Ask us for an example
Prefill
Known details already filled in when the form opens
- Handy for:
- Everyone
- See it in:
- New patient demo, Clinic intake demo
| Feature | What it does | Handy for | See it in |
|---|---|---|---|
| Show and hide questions | Questions appear or skip based on earlier answers | Everyone | Ask us for an example |
| Calculations | Totals and scores worked out automatically (e.g. BMI, quotes) | Clinics, trades, retail | Ask us for an example |
| Grids | A set of questions with the same answer options | Clinics, surveys, HR | Ask us for an example |
| Repeating rows | "Add another" for medications, dependants or items | Clinics, insurance, orders | Ask us for an example |
| Multi-page forms | Long forms split into steps | Everyone | Ask us for an example |
| Reference number | A reference code on each submission | Everyone | Ask us for an example |
| Prefill | Known details already filled in when the form opens | Everyone | New patient demo, Clinic intake demo |
Ratings and scales
Star rating
1–5 or 1–10 stars
- Handy for:
- Hospitality, retail, services
- See it in:
- Ask us for an example
0–10 scale
"How likely are you to recommend us?" style questions
- Handy for:
- Everyone
- See it in:
- GEN-004
Pain scale (0–10)
Tap a number from 0 (no pain) to 10 (worst pain), with numbers or faces
- Handy for:
- Physio, chiro, GPs, dental
- See it in:
- Clinic intake demo, PHY-001
Slider (0–100)
Drag a marker along a line
- Handy for:
- Physio, pain clinics, research
- See it in:
- Ask us for an example
Agree/disagree slider
A labelled sliding scale
- Handy for:
- Surveys, check-ins
- See it in:
- Ask us for an example
| Field | What it does | Handy for | See it in |
|---|---|---|---|
| Star rating | 1–5 or 1–10 stars | Hospitality, retail, services | Ask us for an example |
| 0–10 scale | "How likely are you to recommend us?" style questions | Everyone | GEN-004 |
| Pain scale (0–10) | Tap a number from 0 (no pain) to 10 (worst pain), with numbers or faces | Physio, chiro, GPs, dental | Clinic intake demo, PHY-001 |
| Slider (0–100) | Drag a marker along a line | Physio, pain clinics, research | Ask us for an example |
| Agree/disagree slider | A labelled sliding scale | Surveys, check-ins | Ask us for an example |
Charts and drawing
Body map
Tap one or more areas on a front and back body outline
- Handy for:
- Physio, chiro, massage, osteo, sports, workplace injury
- See it in:
- Clinic intake demo, PHY-001
| Field | What it does | Handy for | See it in |
|---|---|---|---|
| Body map | Tap one or more areas on a front and back body outline | Physio, chiro, massage, osteo, sports, workplace injury | Clinic intake demo, PHY-001 |
Common extras
- Medication list (name, dose and how often)
- Emergency contact and next of kin
- Referral details, with a place to upload the letter
- Allergy and alert questions with follow-ups
- Interpreter needed, preferred language, and Aboriginal and Torres Strait Islander status
- Site induction and SWMS sign-off for trades, with an e-signature
- Patients can fill the form in on a tablet at your front desk
What does it cost?
Fields are part of the form we build for you. A longer form, or one with a body map or scoring, sits in a higher complexity class. We send a quote within hours, before we build an extra form. No payment now. You choose whether to accept. Extra forms start at A$79; see our pricing page.
Ready to see yours?
Send your forms, or start from a template. We'll show you how it looks on a phone.