Build Telepsychiatry Intake Form with Conditional Logic
Budget: $30 – $250 USD
**Project Title**
Psychiatric Intake Form Build (HTML / CSS / JavaScript with Conditional Logic)
**Project Description**
I am seeking a developer to build a structured psychiatric intake form based on a detailed template. The form will be used for a telepsychiatry practice and must preserve the exact wording, structure, and clinical logic of the template.
Because this is a clinical intake document, **all patient-facing content must remain exactly as written in the template.** Questions, wording, answer choices, and section order should not be summarized, condensed, or reworded.
The template includes multiple sections with conditional logic, structured symptom checklists, medication history questions, and diagnostic screening criteria.
---
**Form Requirements**
The form must include:
• All sections from the template implemented exactly as written
• All questions and answer choices included
• Conditional logic that matches the template structure
• Follow-up questions appearing only when appropriate conditions are triggered
• Required field validation where specified
• Multi-page navigation (preferred)
• Clear progress indication for the user if possible
If a conditional question appears, that question should then be required. If the condition is not triggered, the question should be skipped entirely.
Patients should still be able to answer “Unknown” or “N/A” where appropriate.
---
**Technical Requirements**
The completed form should be delivered as editable files so that my web team can maintain it in the future.
Please provide:
• HTML file (form structure and wording)
• CSS file (styling)
• JavaScript file (conditional logic and navigation)
The code should be clearly organized and readable.
The patient-facing wording, question order, answer choices, and clinical logic must remain exactly as written. However, the underlying code structure may use reusable logic patterns (for example repeatable fields or shared conditional logic) where appropriate to simplify implementation.
Styling does not need to be complex or heavily branded — a clean, functional layout is sufficient. Final styling may be adjusted later by my web team.
---
**Documentation**
Please include a brief documentation file explaining:
• Where form sections are located in the HTML
• Where conditional logic is handled in the JavaScript
• How to modify wording or answer choices
• How to add or remove a question if needed
This does not need to be extensive — just enough so that my web development team can maintain the form in the future.
---
**Data Handling**
Please briefly explain how form responses would be handled (for example: email submission, PDF generation, or database storage). A simple submission method is sufficient for this build, as my web team will ultimately implement the form within a secure environment.
---
**Files Provided**
The following files will be provided:
• PDF version of the intake template (authoritative reference)
• Word version of the same template (for easier copying of text)
Both files are identical; the PDF should be used as the reference if anything is inadvertently moved or altered while copying content.
---
**Additional Notes**
This intake form contains detailed clinical screening sections and structured medication history questions, so accuracy and careful implementation are very important.
Please review the template carefully before confirming scope and provide a rough estimate of the hours required.
---
**Deliverables**
• Fully functioning intake form
• Separate HTML / CSS / JavaScript files
• Basic documentation
• Clear instructions for integration into a web environment
Psychiatric Intake Form Build (HTML / CSS / JavaScript with Conditional Logic)
**Project Description**
I am seeking a developer to build a structured psychiatric intake form based on a detailed template. The form will be used for a telepsychiatry practice and must preserve the exact wording, structure, and clinical logic of the template.
Because this is a clinical intake document, **all patient-facing content must remain exactly as written in the template.** Questions, wording, answer choices, and section order should not be summarized, condensed, or reworded.
The template includes multiple sections with conditional logic, structured symptom checklists, medication history questions, and diagnostic screening criteria.
---
**Form Requirements**
The form must include:
• All sections from the template implemented exactly as written
• All questions and answer choices included
• Conditional logic that matches the template structure
• Follow-up questions appearing only when appropriate conditions are triggered
• Required field validation where specified
• Multi-page navigation (preferred)
• Clear progress indication for the user if possible
If a conditional question appears, that question should then be required. If the condition is not triggered, the question should be skipped entirely.
Patients should still be able to answer “Unknown” or “N/A” where appropriate.
---
**Technical Requirements**
The completed form should be delivered as editable files so that my web team can maintain it in the future.
Please provide:
• HTML file (form structure and wording)
• CSS file (styling)
• JavaScript file (conditional logic and navigation)
The code should be clearly organized and readable.
The patient-facing wording, question order, answer choices, and clinical logic must remain exactly as written. However, the underlying code structure may use reusable logic patterns (for example repeatable fields or shared conditional logic) where appropriate to simplify implementation.
Styling does not need to be complex or heavily branded — a clean, functional layout is sufficient. Final styling may be adjusted later by my web team.
---
**Documentation**
Please include a brief documentation file explaining:
• Where form sections are located in the HTML
• Where conditional logic is handled in the JavaScript
• How to modify wording or answer choices
• How to add or remove a question if needed
This does not need to be extensive — just enough so that my web development team can maintain the form in the future.
---
**Data Handling**
Please briefly explain how form responses would be handled (for example: email submission, PDF generation, or database storage). A simple submission method is sufficient for this build, as my web team will ultimately implement the form within a secure environment.
---
**Files Provided**
The following files will be provided:
• PDF version of the intake template (authoritative reference)
• Word version of the same template (for easier copying of text)
Both files are identical; the PDF should be used as the reference if anything is inadvertently moved or altered while copying content.
---
**Additional Notes**
This intake form contains detailed clinical screening sections and structured medication history questions, so accuracy and careful implementation are very important.
Please review the template carefully before confirming scope and provide a rough estimate of the hours required.
---
**Deliverables**
• Fully functioning intake form
• Separate HTML / CSS / JavaScript files
• Basic documentation
• Clear instructions for integration into a web environment