Enterprise: Form Builder Request
Submit a custom form request below. We'll reach out with any clarifying questions and deliver your form within 10 business days.
What's your name?
First Name
Last Name
What is your Healthie account email?
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Double check that it's right. We'll upload the forms to this account.
What is the name of your organization?
Please include sub-org name if going to a specific sub-org of an organization
What is the name of the form?
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If you would like us to build multiple forms, you must submit a request for each form.
Where would you like this form uploaded?
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Production
Staging
Both
Attach the form
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Browse Files
Drag and drop files here
Choose a file
Attach your form template as a PDF (strongly preferred), Word Doc, Google Doc, or CSV. It must be a complete template—include all questions, formatting, and every answer option for any multiple choice or dropdown fields. We can't accept partial templates.
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Is this form an intake form or a charting note template?
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Intake form
Charting note template
If this form is copyrighted, do you have the right to reproduce it?
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Yes
No
It isn't copyrighted
Enable conditional formatting on this form?
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Yes
No
Specify which questions should show or hide based on previous answers.
Example: "If the user selects No on question 14, display question 18."
Enable auto-scoring for this form?
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Yes
No
About auto-scoring
Healthie auto-scoring can only calculate a total sum. Each answer must have a visible numerical value, and the final score is the sum of all values only. Answer weights and scores will be visible to respondents after the form is completed. Custom equations are not supported. Include all scoring instructions and point values on your form template.
Would you like your logo on the form? If so, upload it below.
Browse Files
Drag and drop files here
Choose a file
Cancel
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Details and comments
Share anything else our team should know about your form. The more detail you provide, the better we can build it. This might include dropdown options missing from your template, required fields, or any other preferences.
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