Lunar Healthcare Form
A trustworthy patient intake form designed for healthcare providers, clinics, and telemedicine platforms.
Features
- Two-column form layout — Personal details on the left, medical details on the right
- Quick info strip — HIPAA compliance, board-certified providers, patient-centered care badges
- Form fields — Input, Textarea, native select for insurance, with icon prefixes
- Accessibility — Proper labels, required field indicators, fieldset/legend grouping
- Security footer — SSL encryption and HIPAA compliance notice with submit button
- Calm blue-lavender palette — Clean and trustworthy clinical aesthetic
- Full dark mode — Zinc-based dark scheme with blue accents
Dependencies
@/components/vue-ui/card — Shadcn-Vue Card, CardHeader, CardTitle, CardDescription, CardContent, CardFooter@/components/vue-ui/input — Shadcn-Vue Input@/components/vue-ui/textarea — Shadcn-Vue Textarea@/components/vue-ui/button — Shadcn-Vue Button@/components/vue-ui/badge — Shadcn-Vue Badge@/components/vue-ui/separator — Shadcn-Vue Separator
Customization
- Fields: Add or remove form fields as needed for your intake workflow
- Insurance options: Update the
insuranceOptions array with relevant providers
- Quick info: Edit
quickInfo to highlight your practice's key differentiators
- Colors: Swap blue-600 for your brand's primary color
