Lingo Telehealth Contact Form

Purpose 

A calculated field is the starting point of your calculations. Define the dynamic value you want to calculate (for example score, price, or lead status) and use conditional logic to select the operations you want to perform (add, subtract, multiply, divide, assign or concatenate values). <a href='{{link}}' target='_blank'>Learn more</a>.

Protect your form from spam & bots with reCAPTCHA. Add this block just above your Submit button. <a href='{{link}}' target='_blank'>Learn more</a>.

Use this to offer a range of answers to a question. Respondents can select multiple answers.

Create smart forms based on your respondents' input. Jump to a page, calculate dynamic values, hide specific blocks and require answers. <a href='{{link}}' target='_blank'>Learn more</a>.

Add a divider to separate sections in your form.

Use this for a long list of answer options, like selecting your nationality.

Embed any online content: Google Maps, Calendly, GitHub Gist, online PDFs, Tweets, Figma files and more.

Embed audio from SoundCloud, Spotify, .MP3s and more. Insert this embed block and paste the audio URL or embed link.

Embed video’s from YouTube, Vimeo, Loom, .MP4s and more. Insert this embed block and paste the video’s URL or embed link.

Use this to collect files, like a portfolio or resume.

Big heading suitable for a title of main sections in your form.

Medium heading suitable for a title of smaller sections in your form.

Send custom data from your form link to your form submissions via URL query string parameters. <a href='{{link}}' target='_blank'>Learn more</a>.

Upload an image, add an image URL, or choose from Unsplash. Use images to visualize products or to personalize your form with your visual style.

Use this to allows respondents to pick a date in this format: Month Day, Year.

Use this to collect correctly formatted email addresses as answers. If someone tries to add text in the wrong format, they will have to try again.

Use this to collect correctly formatted links or websites.

Use this if you want a number as a response. Add a minimum and/or maximum number limit.

Use this to collect correctly formatted phone numbers.

Use this for short text answers. Add an answer label or placeholder text for guidance.

Use this to allow respondents to pick a time in this format: XX:XX

Add a text label to an input field and explain what type of answer you expect.

Use this for numeric answers on a scale, to measure client satisfaction for example. Adjust the scale size and add a scale label on the left, center and/or right.

Use this to group similar questions with the same answer options, where each question can be single or multiple select. This is useful when asking multiple questions with the same rating scale.

Use this to offer a range of answer options. Respondents can only choose one answer.

Use this to allow users to select multiple answers from a list of choices.

Add a new page to your form. Use this to create multi-step forms, or to create a custom Thank You page.

Use this to sell products and accept payments securely via Stripe (fees may apply). <a href='{{link}}' target='_blank'>Learn more</a>.

Use this to add a question title and input field at the same time.

Use this to rank options in order of preference or importance. Respondents can drag and drop the options into the desired order.

Use this for a simple and visual way of rating things. Get to know your customers’ opinions about your product or service for example.

Use this to collect electronic signatures for business contracts, agreements, waivers, etc. <a href='{{link}}' target='_blank'>Learn more</a>.

Use this to display any type of text. You can format it as you want and customize it to your needs.

Use this for long form answers without character limits.

Add a ‘Thank you’ page to your form. This is the page your respondents will see after submitting the form.

Add a title to a question in your form. For example: ‘Ready to join our team’ as a part of an application form.

Use this to effortlessly collect wallet addresses with Wallet Connect, providing a seamless and secure connection with the most popular crypto wallets.

Calculated fields

reCAPTCHA

Checkboxes

Conditional logic

Divider

Dropdown

Embed anything

Audio

Video

File upload

Heading 1

Heading 2

Heading 3

Hidden fields

Image

Date

Email

Link

Number

Phone number

Short answer

Time

Label

Linear scale

Matrix

Multiple choice

Multi-select

New page

Payment

Question

Ranking

Rating

Signature

Text

Long answer

‘Thank you’ page

Title

Wallet Connect

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Common issues

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General settings

Instructions

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Troubleshooting

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Works with links of PDFs, Calendly, Google Maps, Tweets, public Figma files and more

Works with SoundCloud, Spotify, MP3s and more

Works with YouTube, Vimeo, Loom, MP4s and more

Easily insert multiple options at once by typing or pasting list of options separated with new lines.

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Search for any input field or layout option. Use <ArrowUp /> and <ArrowDown /> to browse the list, then hit <Enter /> to insert the selected block.

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You can insert a question combined with an input field or just a question title.

Insert questions

Questions

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Collect and receive payments directly on your bank account powered by Stripe.

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Form title

Type a question

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Here are all the integrations connected to this form. You can easily enable or disable an integration and track submission sync requests using the event history log.

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This question is untitled because the input field doesn't have a placeholder text, a label or a question title block above it. You can fix it by editing the form.

Schedule a date on which the form will be closed for new submissions.

Close form on a scheduled date

People won't be able to respond to this form anymore.

Close form

This is what the recipients will see if you closed the form with one of the options above.

Closed form message

Choose in what language the respondents will see your form. This applies to the text which is not customized by you e.g. default buttons, errors, etc.

Text direction

Language

Automatically jump to the next page when a question gets answered. Only works with one multiple choice, dropdown, rating or linear scale question per page.

Auto-jump to next page

Collect answers from people who filled in a part of your form, but didn’t click the submit button. You can't export partial submissions with integrations, nor enable email notifications.

Partial submissions

Enable this setting to require a password before respondents can access the form.

Password protect form

Ensure each respondent can only submit the form once by selecting a form field (e.g. email address, phone number, IP address) that will be used as a unique identifier. This allows our system to detect and prevent duplicate submissions.

Prevent duplicate submissions

The progress bar provides a clear way for respondents to understand how much of the form they have completed, and encourages them to continue until the end.

Progress bar

Redirect to a custom URL when the form is submitted.

Redirect on completion

Tally branding

Send a customized text email to respondents after form submission.

Respondent email notifications

Save answers of not-submitted forms, so respondents can continue from where they left off. The answers are stored in the local browser storage and never leave the respondent’s computer.

Save answers for later

Get an email when someone completes this form. You can fully customize the email's recipient(s), subject and message.

Self email notifications

Automatically delete form submissions after a set period. Enable this option to define how long submissions are stored before they’re deleted. When disabled, submissions will be retained until manually deleted.

Submissions data retention

Set how many submissions you want to receive in total.

Limit number of submissions

Use these options to embed your form into your own website.

Automatically hide the popup after the form is submitted. Optionally set a delay in seconds.

Fully customize the look of your forms with CSS code injection via your custom domain.

After the visitor submits the form, don't show the popup again

Automatically adjust the height of the embed to fit the form content.

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Embed Form

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Form template

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No partial submissions

Collect answers from people who filled in a part of your form, but didn’t click the submit button. Capture data from lost leads, find drop off points and improve your conversion rates. You can't export partial submissions with integrations, nor enable email notifications.

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This log keeps track of all submission sync requests that are sent to Airtable

Airtable events log

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Google Sheets events log

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This log keeps track of all submission sync requests that are sent to Notion

Notion events log

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Slack events log

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Export all form submissions to {{integration}}. Note that exporting may take some time for forms with many submissions.

Export existing submissions

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This webhook hasn't received any events so far.

Webhook events log

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Analyze traffic sources, visitor behavior and time spent

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Create a contact in Hubspot for every new submission

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Generate PDF documents for new form submissions

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Create Trello cards from new form submissions

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Submissions are synced with this <a href='{{link}}' target='_blank'>spreadsheet</a>

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Email notifications

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Collaboration

Remove 5% Tally commission on your incoming payments and only pay the Stripe transaction fee.

No commission

Capture unfinished form responses before respondents submit your form.

Remove all Tally branding and have your forms seamlessly represent your brand.

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Send a fully customized text email to the respondents of your forms.

Remove the 10 MB per file size limit when using the File Upload block.

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Workspaces

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Use this to insert a question with a range of answers. Respondents can select multiple answers.

Use this to insert a question with a long list of answer options.

Use this to insert a question and collect files.

Use this to insert a question that asks respondents to pick a date in this format: Month Day, Year.

Use this to insert a question and collect correctly formatted email addresses as answers. If someone tries to add text in the wrong format, they will have to try again.

Use this to insert a question to collect correctly formatted links or websites.

Use this to insert a question with a number as response. Use settings to add a minimum and/or maximum number limit.

Use this to insert a question and collect correctly formatted phone numbers.

Use this to insert a question combined with a short text answer. Add an answer label or placeholder text for guidance.

Use this to insert a question that allow respondents to pick a time in this format: XX:XX

Use this to insert a question and receive for numeric answers on a scale. Go to settings to adjust the scale size and add a scale label on the left, center and/or right.

Use this to add a question with a range of answer options. Respondents can only choose one answer.

Use this to insert a question and accept payments securely via Stripe (fees may apply). <a href='{{link}}' target='_blank'>Learn more</a>.

Use this for a simple and visual way of rating things.

Use this to insert a question with a long form answer without character limits.

Use this to insert a question title. You can separately add an input field of your choice.

Untitled checkboxes field

Untitled dropdown field

Untitled file upload field

Untitled date field

Untitled email field

Untitled link field

Untitled number field

Untitled phone number field

Untitled short answer field

Untitled time field

Untitled linear scale field

Untitled matrix field

Untitled multiple choice field

Untitled multi select field

Untitled payment

Untitled ranking field

Untitled rating field

Untitled signature

Untitled long answer field

Untitled Wallet Connect field

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Lingo Telehealth Contact Form

Name

Email Address

Phone No

Your Complete Address

Purpose

Please describe your medical concern, and we will reach out to you as soon as possible. If this is a medical emergency, please call 911 immediately.

Please clarify the questions you would like to understand, and remember to include your Federal Communications Commission Practice ID No.