Healthcare
Clinic Appointment Request
Request a clinic visit with one question at a time.
Why use this template
People looking for an eye exam or a frame adjustment should not have to call during desk hours. This request asks which appointment they want, which office, and when they can come in. The opening screen uses a simple glasses photograph, then one question at a time. Customize the appointment menu and office list, and publish it on your booking page.
Part of Formgrid’s healthcare form templates workflow for organised enquiries and lead capture.
- Eye exam, fitting, and frame adjustment choices
- Office, date, and time of day
- A calm opening image beside the first question
- Built to customize for one office or several
What this template collects
- Appointment type
- Preferred office
- Preferred date and time of day
- Optional scheduling note
- Name, email, and phone
- Preferred contact method
Who this template is for
Optometry offices and optical studios taking appointment requests online.
Formgrid features included
- One question on each screen, with a welcome page and a thank you page
- Email notification when a request arrives
- Lead pipeline with New, Contacted, and Converted
- Spam protection on every submission
- Shareable link, or embed the form on your website
- Free to customize. No code required
How it works
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1
Open the live preview and walk through the questions.
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2
Choose Customize Free and edit the wording, colors, and fields.
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3
Publish a link or embed the form on your clinic website.
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4
Each submission lands in Formgrid so your team can follow up.
Live preview
Click through the form, then customize the questions for your own copy.
Frequently asked questions
Can I add contact lens fittings?
Yes. Contact lens fitting is already a choice, and you can add or remove appointment types.
Can patients choose a location?
Yes. The form asks which office to use. Rename the options for your locations.
Can I match the form to my brand colors?
Yes. Change colors, button text, and the intro before you publish.