Filled out the form and then it erases everything

JotForm is manifesting 

Husband is a IT tech and he tried it and after they filled out with correct date, & birthdate it pops up & tells them go back & correct & then erases everything. They said they filled it out 3 times. 

Could you please provide more details about the issue? Also, please provide the form ID or form link so we can investigate it further.

To my understanding, you submit the form and then it erases everything. If you want to check your submissions, please follow this guide: https://www.jotform.com/help/269-How-to-View-Form-Submissions

You can also Enable the Autofill Feature in order to save your data if the browser crashes or if the computer accidentally restarted or closed. To do that, please follow this screen animation guide:

Please help. My patients are very sick with cancer and I need the forms filled out before they can make an appointment. In addition: I have consents in the test area however when they are submiited the consent wording does not show up. Please help. Thank you

Is your issue related to the form http://www.jotform.us/form/72307645684160? I tested that form and I successfully submitted the form.

You will need to provide us more details about your issue, so that we can properly assist you. When was the message 'Go back and fix the issue shown' shown? When the user tried to submit the form? Can you provide us a screenshot of that message? 

If you have an issue with some other form, please provide us the ID of that form. If the form is embedded, provide us the webpage URL, so that we can test the form there. 

Regarding your other question -  I have consents in the test area however when they are submiited the consent wording does not show up.

Where is the wording not shown? On the submission page, inside of the email Notification or somewhere else? What is the exact name of that field? Please provide us a screenshot. 

When I was testing your form I saw another issue. You are collecting SSN and credit card info on plain text fields and that is against our Terms of use. 

Phishing. You agree that Company may terminate your JotForm Service immediately if a form's purpose is found to be deceptively obtaining: sensitive credit card information, social security numbers, user login credentials, or other sensitive personal information. All these activities are considered as Phishing and any account along with the violating forms will be suspended immediately.

Collecting Sensitive Information. You may not use the JotForm to collect certain types of sensitive information, including but not limited to credit card information and any type of login credentials. You may collect some sensitive information such as social security numbers or driver’s license numbers, but you are required to use best security practices of JotForm including SSL and Encrypted Forms features. You are solely responsible for compliance with any data protection and privacy laws and rules applicable to the sensitive information

Card number, expiration date, security codes and card holder name are considered critical information and cannot be collected on plain text fields. The only services allowed to collect such data are those that are DSS/PCI certified.

I deleted mentioned fields from your form to prevent suspension of your account. 

If you want to have payment fields inside of your form you have to use one of JotForm payment tools. 

Inside of this articles you can find out more about payment tools and how to set payment form:

http://www.jotform.com/help/47-Order-Form-Basics 

http://apps.jotform.com/category/payment_processing 

http://www.jotform.com/help/165-Setting-Up-Your-First-Order-Form 

If you want to collect SSN you have to add a sort agreement and/or an e-signature field to the form, so your customers will agree to provide their SSN along with personal info.

Here are some widgets you can add to the form (signature fields):

http://widgets.jotform.com/search/signature 

You can also add this Terms of use widget (for the agreement)

http://widgets.jotform.com/widget/scrollable_text 

You also have to encrypt your form:

Encrypted Forms and How to Use Them