Forms & Surveys

Clinivoz's built-in form builder lets you create intake forms, referral forms, satisfaction surveys, and more — all of which connect directly to your contact database and can trigger automations automatically.

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1. Forms vs. Surveys

Feature	Forms	Surveys
Best for	Intake, referrals, contact requests	Feedback, satisfaction ratings, screening tools
Response format	Fields filled and submitted once	Question-by-question flow, supports logic jumps
Results	Saved to contact record	Saved to contact record; summary view available

Both are built using the same drag-and-drop builder.

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2. Creating a Form

1. Go to Sites > Forms in the left sidebar.
2. Click + New Form.
3. Choose Blank Form or start from a template.
4. Name your form.
5. Build the form using the drag-and-drop editor (see Field Types below).
6. Configure the Submission Settings (see section 5).
7. Click Save.

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3. Field Types

Field Type	Use In Therapy Clinics
Short Text	Name, city, insurance ID, diagnosis
Long Text	"Describe your child's main communication challenges"
Email	Contact email address
Phone	Mobile number (with SMS opt-in checkbox)
Date	Date of birth, evaluation date
Dropdown	Service type, insurance carrier, referral source
Checkbox	SMS consent, multiple applicable conditions
Radio Buttons	Single-select questions (e.g., "How did you hear about us?")
File Upload	Upload insurance cards, referral letters, school IEPs
Signature	Consent signatures, HIPAA authorization
Appointment Booking	Embed calendar booking directly in the form
Hidden Fields	Track the source/campaign that generated the submission (used in URLs)

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4. Recommended Forms for Speech & ABA Clinics

Form 1: Client Intake Form (Speech Therapy)

Suggested fields:

• Parent/Guardian First Name *
• Parent/Guardian Last Name *
• Relationship to Client *
• Parent Email Address *
• Parent Mobile Phone *
• SMS Consent Checkbox — "I agree to receive text messages from [Clinic Name] at the number provided."
• Client (Child) First Name *
• Client Last Name *
• Client Date of Birth *
• Primary Insurance Provider (Dropdown)
• Insurance Member ID
• Group Number
• Primary Concern — Long Text: "Briefly describe the communication or swallowing concerns you've noticed"
• Has your child had a previous speech evaluation? (Radio: Yes / No)
• Referral Source (Dropdown: Physician, School, Parent Research, Insurance, Other)
• Referring Provider Name (if applicable)
• Preferred Appointment Days (Checkboxes: Mon, Tue, Wed, Thu, Fri)
• Preferred Appointment Times (Dropdown: Morning, Afternoon, Evening)
• HIPAA Acknowledgment (Checkbox) *
• Signature *

Form 2: ABA Intake / Referral Form

Suggested fields:

• Referring Provider Name *
• Referring Provider NPI
• Provider Email & Phone *
• Client First Name *
• Client Last Name *
• Client Date of Birth *
• Diagnosis (Dropdown: ASD, ADHD, Other — include ICD-10 if desired)
• Current Insurance (Dropdown)
• Member ID
• Parent/Guardian Name *
• Parent Phone *
• Parent Email *
• Current Services (Checkboxes: Speech, OT, PT, ABA, None)
• Primary Behavioral Concerns (Long Text)
• Has the family received a BCBA assessment before? (Radio: Yes / No)
• Authorization on file? (Radio: Yes / No)
• HIPAA Consent & Signature *

Form 3: Referral Source Contact Form (for Physicians/Schools)

A shorter form for professional referral sources:

• Referral Source Name
• Organization Name
• Phone / Email
• Patient Name
• Patient DOB
• Primary Diagnosis
• Services Requested
• Insurance Information
• Notes

Form 4: Satisfaction Survey

• Overall experience (1–5 star rating)
• "How satisfied are you with your child's progress?" (Dropdown)
• "How would you rate communication with our front desk?" (Dropdown)
• "Would you recommend us to a friend or family member?" (Radio: Yes / No / Not Sure)
• "What could we do better?" (Long Text)
• Permission to use feedback in testimonials? (Checkbox)

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5. Form Submission Settings

After a contact submits a form, configure what happens:

Redirect Options:

• Show a Thank You message (customizable)
• Redirect to a URL (e.g., your website's thank you page or scheduling link)

Auto-Tagging: Automatically apply tags when a form is submitted:

1. In the form settings, go to Submissions > On Submit Actions.
2. Add Add Tag and select the appropriate tag (e.g., New Inquiry, Speech Therapy).

Automation Trigger: Forms can automatically trigger an automation sequence when submitted. Pair your intake form with your New Inquiry Follow-Up automation so the moment someone submits, they immediately receive a response. See Automation Sequences.

Creating/Updating Contacts: By default, form submissions create a new contact record (or update an existing one if the email/phone matches). Make sure your form includes at least one of: email or phone number — otherwise Clinivoz can't create a contact record.

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6. Sharing Your Form

Copy the form link:

1. From the Forms list, click the three-dot menu next to the form.
2. Click Copy Link.
3. Share via SMS, email, or embed on your website.

Embedding on your website:

1. Click the three-dot menu > Embed Code.
2. Copy the <iframe> code.
3. Paste it into your website's HTML (on your intake or contact page).

Including in an automation: Drop the form link into any SMS or email template using a button or hyperlink. For example: "Complete your intake form here: [link]"

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7. Viewing Form Submissions

1. Go to Sites > Forms.
2. Click the form.
3. Click Submissions.
4. View each submission with all field responses.
5. Click a submission to open the associated contact record.

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8. Surveys

Surveys work similarly to forms but are better suited for multi-step experiences.

Creating a Survey:

1. Go to Sites > Surveys.
2. Click + New Survey.
3. Build questions page by page.
4. Use Logic Jumps to route respondents to different questions based on their answers.
5. Configure submission settings.
6. Save and publish.

Good use cases for surveys:

• Post-discharge satisfaction survey
• Annual parent feedback survey
• Screening questionnaire (e.g., a pre-intake questionnaire to determine eligibility)

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