inputSchema: type: object properties: title: Animal Therapy Program Registration pages: - id: 1 name: participant_name label: Full Name hint: First and last name type: text options: [] required: true - id: 2 name: date_of_birth label: Date of Birth hint: null type: date options: [] required: true - id: 3 name: email label: Email Address hint: Contact email type: email options: [] required: true - id: 4 name: phone label: Phone Number hint: Contact phone type: text options: [] required: true - id: 5 name: address label: Street Address hint: Current address type: text options: [] required: true - id: 6 name: city label: City hint: null type: text options: [] required: true - id: 7 name: state label: State or Province hint: null type: text options: [] required: true - id: 8 name: zip_code label: ZIP or Postal Code hint: null type: text options: [] required: true - id: 9 name: emergency_contact_name label: Emergency Contact Name hint: Full name type: text options: [] required: true - id: 10 name: emergency_contact_phone label: Emergency Contact Phone hint: Phone number type: text options: [] required: true - id: 11 name: emergency_contact_relationship label: Emergency Contact Relationship hint: Relationship to participant type: text options: [] required: true - id: 12 name: referral_source label: How Were You Referred to This Program hint: null type: select_one options: - Healthcare Provider - Mental Health Professional - School or Educational Institution - Community Organization - Family or Friend - Online Search - Previous Participant - Other required: true - id: 13 name: referring_professional label: Referring Professional Name hint: If applicable type: text options: [] required: false - id: 14 name: program_type label: Type of Therapy Program hint: Select preferred program type: select_one options: - Individual Animal-Assisted Therapy - Group Animal-Assisted Therapy - Family Animal-Assisted Therapy - Equine-Assisted Therapy - Canine-Assisted Therapy - Assessment and Evaluation required: true - id: 15 name: therapy_goals label: What Are Your Therapy Goals hint: Select all that apply type: select_multiple options: - Reduce Anxiety - Improve Mood - Build Social Skills - Increase Confidence - Process Trauma - Improve Communication - Develop Coping Skills - Enhance Emotional Regulation - Physical Rehabilitation - Other required: true - id: 16 name: animal_preference label: Do You Have an Animal Preference hint: null type: select_one options: - Dogs - Cats - Horses - Rabbits - Birds - No Preference - Have Concerns About Certain Animals required: true - id: 17 name: animal_concerns label: Please Describe Animal Concerns hint: If applicable type: text options: [] required: false - id: 18 name: animal_allergies label: Do You Have Any Animal Allergies hint: null type: select_one options: - No Allergies - Mild Allergies - Moderate Allergies - Severe Allergies required: true - id: 19 name: allergy_details label: Allergy Details hint: Describe allergies type: text options: [] required: false - id: 20 name: animal_experience label: Previous Experience with Animals hint: null type: select_one options: - Extensive Experience - Some Experience - Limited Experience - No Experience - Negative Experience required: true - id: 21 name: experience_details label: Describe Your Experience hint: Brief description type: text options: [] required: false - id: 22 name: animal_fears label: Do You Have Any Fears Related to Animals hint: null type: select_one options: - No Fears - Mild Concerns - Significant Fears - Phobia required: true - id: 23 name: fear_details label: Please Describe Your Fears hint: If applicable type: text options: [] required: false - id: 24 name: medical_conditions label: Relevant Medical or Psychological Conditions hint: That may affect participation type: text options: [] required: false - id: 25 name: current_medications label: Current Medications hint: If relevant type: text options: [] required: false - id: 26 name: session_preference label: Preferred Session Time hint: null type: select_one options: - Morning - Afternoon - Evening - Flexible required: true - id: 27 name: preferred_days label: Preferred Days hint: Select all that apply type: select_multiple options: - Monday - Tuesday - Wednesday - Thursday - Friday - Saturday - Sunday required: true - id: 28 name: session_frequency label: Desired Session Frequency hint: null type: select_one options: - Weekly - Bi-Weekly - Monthly - As Needed - Intensive - Multiple Per Week required: true - id: 29 name: transportation_needs label: Do You Need Transportation Assistance hint: null type: select_one options: - 'True' - 'False' required: true - id: 30 name: accessibility_needs label: Do You Have Any Accessibility Requirements hint: null type: select_one options: - 'True' - 'False' required: true - id: 31 name: accessibility_details label: Accessibility Details hint: If yes describe type: text options: [] required: false - id: 32 name: insurance_info label: Insurance Provider hint: If applicable type: text options: [] required: false - id: 33 name: insurance_id label: Insurance ID Number hint: If applicable type: text options: [] required: false - id: 34 name: payment_method label: Payment Method hint: null type: select_one options: - Insurance - Self-Pay - Sliding Scale - Financial Assistance - Other required: true - id: 35 name: consent_to_treatment label: I Consent to Participate in Animal-Assisted Therapy hint: null type: select_one options: - Yes I Consent - No I Do Not Consent required: true - id: 36 name: liability_waiver label: I Accept the Liability Waiver hint: Understanding risks involved type: select_one options: - Yes I Accept - No I Do Not Accept required: true - id: 37 name: confidentiality_agreement label: I Understand Confidentiality Policies hint: null type: select_one options: - Yes I Understand - No I Need Clarification required: true - id: 38 name: participant_signature label: Electronic Signature hint: Type your full name type: text options: [] required: true - id: 39 name: guardian_signature label: Guardian Signature hint: If under 18 type: text options: [] required: false - id: 40 name: registration_date label: Registration Date hint: null type: date options: [] required: true