Forms

There are a lot of different options for adding contact forms with WordPress. Using this theme, you can quickly add a basic contact form with name, email address, and message with the Getwid contact form below or you can use the recommended ContactForm7 to build more advanced forms with as many fields as you like.

Getwid Contact form

If you just need a basic contact form with just name, email, and message, you can use the pre-built basic contact form block that comes with the Getwid block plugin.

Default Basic Contact Form 7

If you need more fields and flexibility, use the Contact Form 7 recommended plugin to create more fields with options to send to multiple email addresses. Here is the basic default sample form that comes with Contact Form 7.

    Health History Form using Contact Form 7

    Using the free Contact Form 7 plugin, you can create as many fields as you want. This lets you create intake forms, surveys, feedback, applications, and more. Here is a sample Health History form that has a lot of different questions for the client.

      Personal Information

      First Name*

      Last Name*

      Email*

      Home Phone

      Mobile Phone

      Age

      Birthdate

      Place of Birth

      Where do you live now?

      Do you live in a rural or urban area? UrbanRural

      Social Information

      Relationship status

      Children

      Occupation

      Hours of work per week

      Health Information

      Please list your main health concerns and any concerns regarding your gut health.

      Other concerns and/or goals?

      Any serious illnesses/hospitalizations/injuries?

      Do you take any supplements or medications? Please list.

      Have you taken antibiotics before? If so, how many rounds and at what age?

      Have you ever been on proton pump inhibitors?

      Do you or have you ever regularly taken NSAIDS?

      Have you ever had food poisoning? If so when?

      What is your blood type?

      Any practitioners, healers, helpers, or therapies with which you are involved? Please list and explain what you are seeing them for.

      How is/was the health of your mother?

      How is/was the health of your father?

      Would you like your weight to be different? If so, what is your current weight? What would you like it to be?

      Are your periods regular?

      Painful or symptomatic?

      Reached or approaching menopause?

      Gut-Related Information

      Do you experience any:

      Pain, stiffness, or swelling?

      Constipation/Diarrhea/Gas/Bloating?

      Abdominal pain or discomfort?

      Reflux or heartburn?

      Allergies, intolerances, or sensitivities?

      Brain Fog, lack of clarity, lack of focus, or memory loss?

      Low energy, sluggishness, or fatigue? After meals or otherwise?

      Skin issues, acne, or rashes? Please explain.

      Frequent irritability, mood swings, anxiety, or depression?

      Headaches? Please describe frequency and intensity.

      Sinus issues?

      Do you feel you have unexplained inflammation in your body?

      Have you experienced unexplainable rapid weight gain or weight loss in the last year?

      Do you generally feel off or in less than optimal health?

      Are there other symptoms that you would like to note?

      Lifestyle Information

      How is your sleep?

      How many hours do you sleep?

      Do you wake up at night?

      Why?

      How much time do you generally spend outside each week?

      What role do movement and exercise play in your life?

      Do you cook? YesNo

      What percentage of your food is home-cooked?

      Where do you get the rest?

      Do you crave sugar, salt, alcohol, or cigarettes or have any other cravings or addictions?

      Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?

      Nutrition Information

      What foods and drinks did you consume often as a child?

      FruitVegetablesNutsSeedsWhole GrainsBeans/LegumesMeatFisheggsdairybreadsSweet baked goodsPackaged Savory Foods (chips, crackers,etc.)Packaged Sweet FoodsFrozen DinnersDessertsCandySodaJuiceWater

      Please list any other foods.

      What is your food and drink like these days?

      FruitVegetablesNutsSeedsWhole GrainsBeans/LegumesMeatFisheggsdairybreadsSweet baked goodsPackaged Savory Foods (chips, crackers,etc.)Packaged Sweet FoodsFrozen DinnersDessertsCandySodaJuiceWater

      Please list any other foods.

      The most important thing I could do to improve my health is:

      Additional Comments

      Anything else you would like to share?