Test: Submit a request with conditional fields

Test Form

Subject(Required)

Please provide a summary of your request

Description(Required)

Does your query fit into one of these categories?(Required)

Patient's name(Required)

First name Surname

Please enter your patient's name

Patient's Date of Birth(Required)

Please enter your patient's date of birth

Hidden

{user:user_email} {user:user_email}

Phone

This field is for validation purposes and should be left unchanged.