A Guide to Form Fields

The following is a list of form fields for use with the Form Builder. This article lets you see what they look like before you implement them in your own forms.
Fields list:
NOTE: For a refresher on using the Form Builder, read our article on What is the Form Builder?
Acknowledgment Checkbox |
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The Acknowledgement Checkbox is a checkbox that is used in place of initials on a paper form. |
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The available options for this component are:
The animation below shows you how to add this form field to your form: |
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Appointment Reminder Preferences |
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This field collects approvals from patients regarding sending email and text messages for appointment reminders. You may edit the text of the questions, but the default should suffice. |
The only options for this component are Destination, where you select where it will appear (iPad, Online, or both), and whether the field buttons appear in English or Spanish. |
Checkboxes |
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This is used as a list of values where the patient can check one or more values from the list. An example of checkboxes is “how long has it been since your last visit? (i.e., 3 months, 6 months, 1 year, more than 1 year). |
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The available options for this component are:
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Data Row |
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The Data Row field works differently from other form fields. This field allows you to include more than one element in single row. You can add Label, Text, List, Checkbox, Yes/No, and Image elements. |
To add a Data Row:
The Select Question Type dialog box will open.
The Data Row dialog box will open.
The Add dialog box will open.
The available Types are as follows:
Repeat steps 3-5 until you’ve added all your data row elements.
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Filler |
This component adds empty space for a better aesthetic layout. The only available option is to set the height, in pixels, of the Filler object. NOTE: This field does not display any visible elements. |
The animation below shows you how to add this form component to your form: |
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Headers |
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This is the title of the form being created or modified that appears at the top of any form. Common examples are “Dental History” or “HIPAA Notice of Privacy Practices.” |
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The available options for this component are:
The animation below shows you how to add this component to your form: |
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Images |
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The Image field allows you to add an image to your form. |
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The available options for this component are:
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Labels |
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Use the Label component to mark logical sections or groups of questions. |
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The available options for this component are:
The animation below shows you how to add this form component to your form: |
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Lists |
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This is used as a drop-down list where the patient can select only one value from the list. Examples of lists are gender, marital status and employment status. |
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The available options for this component are:
The animation below shows you how to add this form field to your form: |
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Medical Conditions |
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This field allows the patient to select pre-existing conditions. |
You can choose from a selection of pre-defined titles or write your own. In addition, you have the option to add an "I checked all that apply" checkbox to the bottom of the form. The animation below shows you how to add this form field to your form: |
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Multi-Line Text |
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Used for text input for an explanation that requires more than one line such as list of conditions, list of medications and comments. |
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Available Multi-line Text options are:
The animation below shows you how to add this form field to your form: |
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Page Break |
Adding this field will divide your form into pages, but it is only designed to work on iPad forms. This page break will not have any effect on the online version of the form. |
The animation below shows you how to add this form field to your form: |
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Page Break Online |
Adding this field will divide your form into pages but only for online forms. This page break will not have any effect on the iPad version of the form. |
The animation below shows you how to add this form component to your form: |
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Paragraph |
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This is used for the majority of larger body texts that contain several paragraphs of text. A common example is the main text body for consent forms. |
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The available options are:
The animation below shows you how to add this form component to your form: |
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Patient Address |
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This field collects address information for patients. |
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The available options for this field are:
NOTE: You can only use one Patient Address field per form. In addition, you have the option to add an "I checked all that apply" checkbox to the bottom of the form. The animation below shows you how to add this form field to your form: |
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Patient Birthdate, Weight, Age |
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This field is a combination field used to collect patient birthday, age, and optional weight values. |
Aside from making the answer required, the options available are to include a border and to choose English or Spanish language versions. The animation below shows you how to add this form field to your form: |
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Patient Name |
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Selecting this field creates the First Name and Last Name fields. You can also choose to display a field for a patient's birthday. |
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Referred By |
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This field is a simple text field for collecting the name of the doctor who referred the patient to your practice. By default, the tag is automatically selected. The only option is if you would like for this field to be required. |
By default, the tag is automatically selected. The only option is if you would like for this field to be required. The animation below shows you how to add this form field to your form: |
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Segmented |
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This is used as a list where the patient can select only one of the values visible as buttons next to each other on the form. |
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The available options for this component are:
The animation below shows you how to add this form field to your form:
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Separator |
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A separator is a horizontal line across your form. |
The only options for this component are Color and Height (in pixels). To change the color of the separator, double-click the color box.
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Signature |
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The signature should be used by default on every form created unless you choose otherwise. It is usually the last field on your form. Alongside the patient signature, you can add a doctor or witness signature. |
The Is required checkbox makes it mandatory for the patient/doctor to sign the form before it is saved. The Add name checkbox displays a field for the patient to enter their name under the signature line. Add “Doctor” or “Witness” to the Footer field if the signature you are creating is for a doctor or a witness. |
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Single-Line Text |
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This is used for text input such as name, phone number, and email. |
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Available Single-line Text options are:
The animation below shows you how to add this form field to your form: |
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Student Status |
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This field asks the patient about their student status. |
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The available options for this field type are:
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Web Popup |
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This is used to add a hyperlink on your form that links and opens a webpage or a local HTML file. |
Type the text that will be displayed on your form in the Title field then the URL in the Location field. You also need to specify the source of the link by selecting Local or Internet from the Location radio group.
The animation below shows you how to add this form component to your form: |
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Yes/No Question |
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Used for answering questions that have “Yes” or “No” answers. Examples are “Do you smoke?”. It can also be used for conditional questions like “Do you like your smile, if no why?” |
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The available options for this field type are:
The animation below shows you how to add this form field to your form: |
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