Has your child been seen at our practice before?

Has your child been seen at our practice before?
  • [[{"field_id":32685,"subrules":{"field_id":32684,"value":"Yes","operator":"Match"}}],[{"field_id":32686,"subrules":{"field_id":32684,"value":"No","operator":"Match"}}]]

How many patients would you like to schedule?

How many patients would you like to schedule?
  • [[{"field_id":32687,"subrules":{"field_id":32685,"value":"1 child","operator":"Match"}}]]

How many patients would you like to schedule?

How many patients would you like to schedule?
  • [[{"field_id":32688,"subrules":{"field_id":32686,"value":"1 child","operator":"Match"}}]]

What type of visit would you like to schedule? 

What type of visit would you like to schedule? 
  • [[{"field_id":32690,"subrules":{"field_id":32687,"value":"Established patient well visit","operator":"Match"}}],[{"field_id":32690,"subrules":{"field_id":32687,"value":"Established patient sick visit\u00a0","operator":"Match"}}]]

What type of visit would you like to schedule? 

What type of visit would you like to schedule? 
  • [[{"field_id":32689,"subrules":{"field_id":32688,"value":"New patient well visit","operator":"Match"}}],[{"field_id":32689,"subrules":{"field_id":32688,"value":"New patient sick visit","operator":"Match"}}]]

Are you using insurance for your visit? 

Are you using insurance for your visit? 
  • [[{"field_id":32691,"subrules":{"field_id":32689,"value":"Yes","operator":"Match"}}]]

Has your insurance changed since your last visit? 

Has your insurance changed since your last visit? 
  • [[{"field_id":32692,"subrules":{"field_id":32690,"value":"Yes","operator":"Match"}}],[{"field_id":32692,"subrules":{"field_id":32690,"value":"No","operator":"Match"}}]]

Which insurance will you be using for your visit?

Which insurance will you be using for your visit?

Do any of these apply to your child? 

Do any of these apply to your child?