Pediatric clinic inquiry form

Why use this template

Families should not have to explain everything in one text box. This pediatric inquiry asks what the message is about, an optional child first name, an age group, and who is writing. It is an office inquiry, and the last step asks them to leave out clinical details. Customize the inquiry types for new families, scheduling, and billing questions.

Part of Formgrid’s healthcare form templates workflow for organised enquiries and lead capture.

• Written for a parent or guardian, not a generic contact form
• Optional child first name and an age group
• Guardian name, relationship, email, and phone
• Clear stop before clinical detail

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

1. 1

   Open the live preview and walk through the questions.

2. 2

   Choose Customize Free and edit the wording, colors, and fields.

3. 3

   Publish a link or embed the form on your clinic website.

4. 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