I am trying to create a jotform integrated with Stripe that would allow

I am trying to create a jotform integrated with Stripe that would allow up to put in the different amount of copays and deductibles owed for medical visit fees

Hi there,

Happy to help!

We do have a payment integration with Stripe, but in order for me to guide you on how best to set this up, I'll need just a little more information.

Do you require the form respondents to indicate the amount themselves, or will these amounts be preset?

We want to present the amounts
It will vary depending on co pay etc
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Hi again,

Thank you for your response!

Please allow me a little time to investigate potential options and possibly present some different examples, and I will get back to you via this thread as soon as possible.

Thank you in advance for your patience and understanding!

Hi again,

Thank you again for your patience as I tested some options for you.

I have put together a very simply, straightforward demo form here (it is currently in Test Mode with the Stripe integration): https://form.jotform.com/212936926335058

First, I have a dropdown where the respondent can indicate which Co-Pay they are utilizing (for the purposes of my example, I have named them simply):

Next, I've added a Form Calculation Widget and hidden it:

Then I added the Stripe integration, and set it to User Defined Amount under Payment Type, also indicating that the amount would come from our Form Calculation field (this is important so that the amount cannot be modified):

Next, we're going to set our conditions to change the amount in the Form Calculation field depending on which Co-Pay they select:

We would repeat the same condition for each Co-Pay, except we would change the amount dependent on the co-pay. Your conditions would look like this when complete:

Now, the form works like this:

Would this be a viable for you?