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Application NameTestBenevis Form NamePatientIntake Form TitlePatient Intake Form Form DescriptionPatient Intake form { "inline" : true, "hidden_input" : false, "language" : "en", "statusbar" : false, "menubar" : false, "plugins" : "lists link", "toolbar" : "bold italic | bullist numlist outdent indent | link", "browser_spellcheck" : true, "encoding" : "xml", "entity_encoding" : "raw", "forced_root_block" : "div", "visual_table_class" : "fr-tinymce-table", "skin" : false, "convert_urls" : false, "sandbox_iframes" : true, "convert_unsafe_embeds": true }

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Orbeon Form Builder

Patient Intake Form