Has your child been seen at our practice before?

  • [[{"field_id":27347,"subrules":{"field_id":27346,"value":"Yes","operator":"Match"}}],[{"field_id":28272,"subrules":{"field_id":27346,"value":"No","operator":"Match"}}]]

How many patients would you like to schedule?

  • [[{"field_id":27348,"subrules":{"field_id":27347,"value":"1 child","operator":"Match"}}]]

How many patients would you like to schedule?

  • [[{"field_id":28271,"subrules":{"field_id":28272,"value":"1 child","operator":"Match"}}]]

What type of visit would you like to schedule? 

  • [[{"field_id":28268,"subrules":{"field_id":27348,"value":"Established patient well visit","operator":"Match"}}],[{"field_id":28268,"subrules":{"field_id":27348,"value":"Established patient sick visit\u00a0","operator":"Match"}}]]

What type of visit would you like to schedule? 

  • [[{"field_id":28267,"subrules":{"field_id":28271,"value":"New patient well visit","operator":"Match"}}],[{"field_id":28267,"subrules":{"field_id":28271,"value":"New patient sick visit","operator":"Match"}}]]

Are you using insurance for your visit? 

  • [[{"field_id":28270,"subrules":{"field_id":28267,"value":"Yes","operator":"Match"}}]]

Has your insurance changed since your last visit? 

  • [[{"field_id":28269,"subrules":{"field_id":28268,"value":"Yes","operator":"Match"}}],[{"field_id":28269,"subrules":{"field_id":28268,"value":"No","operator":"Match"}}]]

Which insurance will you be using for your visit? 

Do any of these apply to your child?