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Sample Form: نوبت دندانپزشکی

نوع خدمت، پزشک، زمان و توضیح مشکل؛ با یادآوری پیامکی.

7 questions · Free up to 50 responses a month

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About this template

“نوبت دندانپزشکی” has 7 questions; 4 are required and 3 optional. Question types: Short text (2), Dropdown (2), Mobile number (1), Booking (1), Yes / No (1). 9 ready-made options across 2 choice questions, all editable in the online version.

In the online version of this template

  • Mobile numbers are validated against the Iranian number format.
  • Appointments can only be picked from free time slots.
Related:Online form builderBooking

Questions in this template

  1. 1.

    نام و نام خانوادگی *

    (Short text)
  2. 2.

    شماره موبایل *

    (Mobile number)
  3. 3.

    خدمت *

    (Dropdown)
    • معاینه
    • جرم‌گیری
    • ترمیم
    • عصب‌کشی
    • ارتودنسی
    • ایمپلنت
  4. 4.

    پزشک

    (Dropdown)
    • دکتر الف
    • دکتر ب
    • فرقی ندارد
  5. 5.

    زمان *

    (Booking)
  6. 6.

    درد دارید؟

    (Yes / No)
  7. 7.

    توضیح

    (Short text)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
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Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “نوبت دندانپزشکی”.
  3. Change the questions as you like, publish the form and send the link.

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