'patient-intake-questionnaire', 'title' => 'Duckform Patient Intake Sample Questionnaire', 'description' => 'This is a sample questionnaire with two sections.', 'sections' => [ [ // Section #1 'title' => 'Profile Information', 'description' => null, 'slug' => 'profile-information', 'order' => 1, 'questions' => [ [ 'required' => true, 'text' => 'Name', 'type' => 'free_text', 'possibleAnswers' => [ [] ], ], [ 'required' => true, 'text' => 'Email Address', 'type' => 'free_text', 'possibleAnswers' => [ [] ], ], [ 'required' => false, 'text' => 'Phone Number', 'type' => 'free_text', 'possibleAnswers' => [ [] ], ], [ 'required' => false, 'text' => 'Date of Birth', 'type' => 'date', 'possibleAnswers' => [ [] ], ], [ 'required' => true, 'text' => 'Height', 'type' => 'integer', 'possibleAnswers' => [ ['text' => 'inches'], ], ], [ 'required' => true, 'text' => 'Weight', 'type' => 'integer', 'possibleAnswers' => [ ['text' => 'lbs'], ], ], [ 'randomize_possible_answers' => true, 'required' => false, 'text' => 'Are you under the care of any of the following?', 'type' => 'multiselect', 'possibleAnswers' => [ ['text' => 'Primary Care Doctor'], ['text' => 'Osteopath'], ['text' => 'Chiropractor'], ['text' => 'Naturopath'], ['text' => 'Cardiologist'], ['text' => 'Rheumatologist'], ['text' => 'Gastroenterologist'], ['text' => 'Neurologist'], ['text' => 'Endocrinologist'], ['text' => 'Acupuncturist'], ['text' => 'Other', 'order' => 1], ], ], ], ], [ // Section #2 'title' => 'Medical History', 'description' => null, 'slug' => 'medical-history', 'order' => 2, 'questions' => [ [ 'randomize_possible_answers' => false, 'required' => false, 'text' => 'How motivated are you to accomplish your goal?', 'type' => 'single_select', 'possibleAnswers' => [ ['text' => "Very motivated - Let's do this!"], ['text' => 'Semi-motivated - I will try my hardest.'], ['text' => 'Still trying to find my motivation.'], ], ], [ 'randomize_possible_answers' => false, 'required' => true, 'text' => 'I am motivated to change my diet', 'type' => 'scale', 'possibleAnswers' => [ ['text' => 'Not Motivated'], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => 'Very Motivated'], ], ], [ 'randomize_possible_answers' => false, 'required' => true, 'text' => 'I am motivated to get on a supplement routine', 'type' => 'scale', 'possibleAnswers' => [ ['text' => 'Nothing'], ['text' => null], ['text' => null], ['text' => null], ['text' => 'A lot!'], ], ], [ 'randomize_possible_answers' => false, 'required' => true, 'text' => 'I am motivated to make lifestyle changes', 'type' => 'scale', 'possibleAnswers' => [ ['text' => 'Not Motivated'], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => null], ['text' => 'Very Motivated'], ], ], [ 'randomize_possible_answers' => false, 'required' => false, 'text' => 'I have a gallbladder', 'type' => 'yes_no', 'possibleAnswers' => [ ['text' => 'Yes'], ['text' => 'No'], ], ], [ 'randomize_possible_answers' => false, 'required' => false, 'text' => 'Blood Sugar / Metabolism', 'type' => 'multiselect', 'possibleAnswers' => [ ['text' => 'Dizzy upon standing'], ['text' => 'Tiredness or sugar craving directly after a meal'], ['text' => 'Not hungry for breakfast'], ['text' => 'Difficulty gaining weight'], ['text' => 'Difficulty losing weight'], ['text' => 'Poor circulation'], ['text' => 'None of the above'], ['text' => 'Other', 'order' => 1], ], ], ], ], ], ];