Website Survey Form 10/26

Please provide appropriate value in each field's default value property as per Analytics Tech Specs

Form Name:

Form Category:

Account Management, Contact, Interactions, Quiz, Registration, Services

Form Sub-Category:

Password Resets, Login, Profile, Representative, Contact Us, Polls, Social Share, Doctor Discussion Guide, Dosing Guide, Symptom Checker, Knowledge Assessment, Event, More Info, Sign Up, Saving Card, Benefit Verification, Benefit Enrollments, Medical Exception, Injection Form, Share a Story

Form MVA Name:

Form MVA Type:

Download, Form, Link, Share, Tool, Video

Form MVA Tier:

Form MVA Category:

Savings Card, Insurance, Symptom Journal, Test Score Tracker, Condition Information, Doctor Discussion Guide, Dosing Information, Enrollment Form, Flashcard, Medical Exception, Patient Counseling Guide, Savings Card, Symptom Journal, Doctor Discussion Guide, Doctor Search, Dosage Calculator, Enroll, Med Reminders, Quick Poll, Resource Request, Symptom Quiz, UGC Submission, Contact Rep, Savings Card, Social Share, App Store, More Info, Patient Resources, Share Information, Share Results, Submit a Story, Assessment Tool, Benefits Verification, Carousel, Initiation, Myth versus Fact, Workaround Quiz, Formulary Tool, Image Expand, Medical Exception, Q And A, Slider, Administration Instructions, Condition Information, Insurance, Inventory, Mechanism of Action, Patient Story, Product Overview, Program Overview, Injection Training, Other

Form PII Field Names for Masking:

Form Analytics Payload:

{   "fieldseparator": "|",   "valueseparator": "+",   "formfields": [     {       "formelementname": "",       "formelementcss": "surveyform-slider",       "payloadfieldname": "Emoji Selector",       "payloadfieldvalue": "",       "formValue": "",       "type": "slider"     },     {       "formelementname": "question2Dropdownlist",       "formelementcss": "",       "payloadfieldname": "How did you hear about us?",       "payloadfieldvalue": "",       "formValue": "",       "type": "input"     },     {       "formelementname": "question3Dropdownlist",       "formelementcss": "",       "payloadfieldname": "Was the website easy to use?",       "payloadfieldvalue": "",       "formValue": "",       "type": "input"     },     {       "formelementname": "infoAboutChronicMigraineQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "storiesTipsChronicMigraineQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "savingsforBotoxQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "migraineSpecialistToolQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "migrainesTrackerQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "findAnythingUsefulQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "otherQues4Checkbox",       "formelementcss": "",       "payloadfieldname": "What were you looking for? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "informationChronicMigraineQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "storiesTipsChronicMigraineQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "savingsforBotoxQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "migraineSpecialistToolQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "migrainesTrackerQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "findAnythingUsefulQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     },     {       "formelementname": "otherQues5Checkbox",       "formelementcss": "",       "payloadfieldname": "What resource did you find useful? Select any that apply",       "payloadfieldvalue": "",       "formValue": "text",       "type": "checkbox"     }   ] }

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