Custom Form Build With Zapier Integration

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 -

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

Habilidades: PHP, WordPress, HTML, JavaScript, CSS

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Acerca do Empregador:
( 35 comentários ) Houston, United States

ID do Projeto: #29080583

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