Custom Form Build With Zapier Integration
Orçamento $250-750 USD
I am looking to replace a current lead generation form on my current website.
For an example of what I am looking to replace, please see - https://hairtransplantdallastx.com.
Click on any one of the "consultation" buttons to get an idea of the function of what I am looking for.
**Three VERY IMPORTANT features and functions:**
- Form MUST have popup function/capability.
- Form MUST integrate with Zapier
- Form MUST be compatible with WordPress
- Form MUST come with a basic CRM to track all form submissions
Rather than the simple 4 questions I am asking now, I would like a multi-step form that displays the same way.
Here are the steps I would like to include:
1. Norwood classification (image selection)
- User will choose from 10 images of what their hair loss looks like
2. Are you on any hair loss medication or have you had a procedure in the past? (multiple selection)
- User will choose between a drop down menu and radio box options
3. Hair loss photo upload (optional for users)
4. How would you like to meet Dr. Smith? (single answer option)
- User will choose Virtual, In-Person or Phone consultation
5. Contact Information (three input fields)
- User will input Name, Phone and Email Address
6. Contact Preference (dropdown options)
- User will choose the best way to contact and the best time to contact
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