Fill Intake Form

This is the live form. The patient (or client) sees the labels translated into their language. Each field uses the right input — text box, dropdown, date, or checkbox. Consent is required before the form can be submitted.

1. 1
   Patient language

   Two-letter language code. Drives the auto-translation of every field label.

2. 2
   Text field

   Free-form text input. Multiline.

3. 3
   Select field

   Tap to open a dropdown of preset options.

4. 4
   Date field

   Text input in YYYY-MM-DD format.

5. 5
   Checkbox field

   Single yes/no toggle.

6. 6
   Consent checkbox

   Required. Confirms the patient agrees to collection and processing of the data.

7. 7
   Submit form

   Sends the responses. Disabled until consent is given. Returns you to the forms list.