export default { "steps": { "page0": { "elements": [ "h3", "h4", "injury_type" ], "buttons": { "previous": false } }, "page1": { "elements": [ "h2_1", "h4_1", "injury_time", "pain_level" ] }, "page2": { "elements": [ "h2", "h4_2", "chronic_conditions", "chronic_conditions_reason" ] }, "page3": { "elements": [ "h4_3", "serious_injuries", "serious_injuries_description" ] }, "page4": { "elements": [ "h2_2", "h4_4", "current_medications" ] }, "page5": { "elements": [ "h4_5", "swelling", "swelling_description" ] }, "page6": { "elements": [ "h2_3", "h4_6", "mobility_issues" ] }, "page7": { "elements": [ "h4_7", "rehabilitation_services", "rehabilitation_services_description" ] }, "page8": { "elements": [ "h2_4", "h4_8", "previous_peptide_therapies", "previous_peptide_therapies_description" ] }, "page9": { "elements": [ "h4_9", "peptide_sensitivities" ] }, "page10": { "elements": [ "h4_10", "pregnant" ] } }, "schema": { "h3": { "type": "static", "tag": "h2", "content": "Injury Repair", "align": "left" }, "h4": { "type": "static", "tag": "h4", "content": "What type of injury are you seeking treatment for?" }, "injury_type": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "muscle strain", "label": "Muscle Strain" }, { "value": "joint injury", "label": "Joint Injury" }, { "value": "ligament tear", "label": "Ligament Tear" }, { "value": "other", "label": "Other" } ] }, "h2_1": { "type": "static", "tag": "h2", "content": "Injury Details" }, "h4_1": { "type": "static", "tag": "h4", "content": "How long ago did the injury occur?" }, "injury_time": { "type": "text", "inputType": "text", "rules": [ "required" ] }, "pain_level": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "1", "label": "1 (Mild)" }, { "value": "2", "label": "2" }, { "value": "3", "label": "3" }, { "value": "4", "label": "4" }, { "value": "5", "label": "5" }, { "value": "6", "label": "6" }, { "value": "7", "label": "7" }, { "value": "8", "label": "8" }, { "value": "9", "label": "9" }, { "value": "10", "label": "10 (Severe)" } ] }, "h2": { "type": "static", "tag": "h2", "content": "Medical History" }, "h4_2": { "type": "static", "tag": "h4", "content": "Have you been diagnosed with any chronic medical conditions (e.g., diabetes, heart disease)?" }, "chronic_conditions": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "chronic_conditions_reason": { "type": "text", "label": "If yes, please specify the condition.", "rules": [ "required" ], "conditions": [ [ "chronic_conditions", "in", [ "Yes" ] ] ] }, "h4_3": { "type": "static", "tag": "h4", "content": "Do you have a history of any serious injuries or surgeries?" }, "serious_injuries": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "serious_injuries_description": { "type": "text", "label": "If yes, please describe.", "rules": [ "required" ], "conditions": [ [ "serious_injuries", "in", [ "Yes" ] ] ] }, "h2_2": { "type": "static", "tag": "h2", "content": "Current Medications" }, "h4_4": { "type": "static", "tag": "h4", "content": "Are you currently taking any medications or supplements?" }, "current_medications": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "h4_5": { "type": "static", "tag": "h4", "content": "Are you experiencing any swelling, bruising, or redness in the affected area?" }, "swelling": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "swelling_description": { "type": "text", "label": "If yes, please describe.", "rules": [ "required" ], "conditions": [ [ "swelling", "in", [ "Yes" ] ] ] }, "h2_3": { "type": "static", "tag": "h2", "content": "Mobility Issues" }, "h4_6": { "type": "static", "tag": "h4", "content": "Are you having any issues with mobility or range of motion in the affected area?" }, "mobility_issues": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "h4_7": { "type": "static", "tag": "h4", "content": "Have you undergone any physical therapy, chiropractic care, or other rehabilitation services for this injury?" }, "rehabilitation_services": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "rehabilitation_services_description": { "type": "text", "label": "If yes, please describe.", "rules": [ "required" ], "conditions": [ [ "rehabilitation_services", "in", [ "Yes" ] ] ] }, "h2_4": { "type": "static", "tag": "h2", "content": "Previous Treatments" }, "h4_8": { "type": "static", "tag": "h4", "content": "Have you used any other peptide therapies or similar treatments in the past?" }, "previous_peptide_therapies": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "previous_peptide_therapies_description": { "type": "text", "label": "If yes, please describe the results.", "rules": [ "required" ], "conditions": [ [ "previous_peptide_therapies", "in", [ "Yes" ] ] ] }, "h4_9": { "type": "static", "tag": "h4", "content": "Do you have any known sensitivities to peptide-based therapies?" }, "peptide_sensitivities": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] }, "h4_10": { "type": "static", "tag": "h4", "content": "Are you Pregnant? (Female Specific)" }, "pregnant": { "type": "radiogroup", "rules": [ "required" ], "view": "blocks", "items": [ { "value": "Yes", "label": "Yes" }, { "value": "No", "label": "No" } ] } } }