Are you a current Patient?
[amp_multibox values="Yes | No" placeholder="Are you a current Patient" name="are_you_a_current_Patient" type="radio"]
Preferred time(s) to call?
[amp_multibox values="Morning | Noon | Afternoon | Evening" placeholder="Preferred time(s) to call" name="preferred_time_to_call" type="radio"]
Preferred day(s) of the week for an appointment?
[amp_multibox values="Any Day | Monday | Tuesday | Wednesday | Thursday | Friday" placeholder="Preferred day(s) of the week for an appointment" name="Preferred_days_of_the_week_for_an_appointment" type="radio"]
Preferred time(s) for an appointment?
[amp_multibox values="Any Time | Morning | Noon | Afternoon | Evening" placeholder="Preferred time(s) for an appointment" name="preferred_times_for_an_appointment" type="radio"]
