Some Form Elements
Form Classes
- hs-form
- form-columns-1: Wrapper with 1 column for inputs.
- form-columns-2: Wrapper with 2 columns for inputs.
Fields
Input Fields
Error Messages
- hs-error-msgs: A list of error messages related to form fields.
- hs-error-msg: Specific error message for each field.
Checkboxes
- hs-form-booleancheckbox:
- Workers comp (High paper EOB volume)
- I agree to be contacted to complete the audit
- Legal / lien (Reconciliation-heavy)
Radio Buttons
Success Messages
- Thank you! Your submission has been received!
Verify Checkbox Methods
- Auto / PI (No payer portal access)
Contact Information
- First Name
- Middle Name
- Last Name
- Title/Role
- Phone Number
- Email
- Practice
- Number of providers
- Current EHR:
- Epic
- WebPT
- Athena
- Healthe
- ClinicalWorks
- Greenway Health
- Other
- Do you currently use a lockbox service:
- No
- Yes, with another provider
- Not sure
Claim Type Handled
- Workers comp
- Auto / PI
- Legal / lien
- Standard insurance (Commercial / Medicare)
Submission UTM Parameters
- utm_source
- utm_medium
- utm_campaign
- utm_id
- utm_term
- utm_content
General Submission Messages
- Oops! Something went wrong while submitting the form.
Additional Fields
- Last Name
- Product Interest:
- Revenue Cycle Management
- Athelas Air
- Ambient AI
- Athelas Agents
- Ambient AI (formerly Scribe)
- How did you hear about us?
- Advertising
- Event / Tradeshow
- News / media
- Online Search
- Other
- Referral
- Social Media
- Webinar / Podcast
- Page ID
- Care Setting:
- Clinic
- Infusion Center
- Behavioral Health
- Community Program
- Home
- Other