Please fill in below and our customer service will help you.
{"fields":[{"id":"9b33add6-ee8d-4fea-93a1-e54b5c46c384","name":"pleasechooseoneofthebelowoptions","label":"Please choose one of the below options","hideLabel":false,"value":[],"type":"Checkbox","required":true,"multiple":true,"options":[{"label":"Existing customer","value":"Val 1"},{"label":"New customer","value":"Val 2"}],"width":100},{"id":"b37e6a13-519b-43b2-9db5-577641b2d69a","name":"youremail","label":"Your e-mail","hideLabel":false,"value":[],"type":"Email","required":true,"multiple":false,"options":[],"width":100},{"id":"77d46e59-9786-4797-910c-50f3ed98b082","name":"nameofyourhospital","label":"Name of your hospital","hideLabel":false,"value":[],"type":"Text","required":true,"multiple":false,"options":[],"width":100}],"submitButtonText":"Send","blockSystemId":"1c0f4678-1af2-4749-8366-b4efca6dc74f"}