This guide shows you how to create the Adobe Sign web form with your exact fields and configure the dual‑signature workflow where:

1. Patient completes intake form and signs
2. Adobe Sign emails Doctor for review
3. Doctor reviews and digitally signs to approve
4. Webhook fires to WordPress to grant shop access

Step 1: Create Your Form in Microsoft Word or PDF Editor

TRIAD DEXA
Body Composition Scan - Client Intake & Medical Clearance Form

Business Name: Triad DEXA
Facility Address: 4361 Federal Drive, STE 180, Greensboro, NC 27410
Email: Info@TriadDEXA.com

CLIENT INFORMATION Section:

• Full Name: _______________
• Date of Birth: _______________    Age: _____    Sex: ☐ Male ☐ Female
• Phone Number: _______________
• Email Address: _______________
• Mailing Address: _______________
• Emergency Contact Name: _______________
• Emergency Contact Phone: _______________
• Relationship to You: _______________

MEDICAL BACKGROUND Section:

1. Are you currently pregnant or think you may be pregnant? ☐ Yes ☐ No
   (Note: Scans cannot be performed during pregnancy)
2. Have you had a DEXA scan in the last 6 months? ☐ Yes ☐ No
   If yes, approximate date and location: _______________
3. Do you have any implanted medical devices (e.g., pacemakers, metal rods)? ☐ Yes ☐ No
   If yes, please describe: _______________
4. Do you have any current or recent injuries that may affect your positioning for the scan? ☐ Yes ☐ No
   If yes, please describe: _______________
5. Are you currently under the care of a physician for any medical condition? ☐ Yes ☐ No
   If yes, please explain: _______________
6. What is your primary reason for getting a DEXA scan? (check all that apply)
   ☐ General health & fitness   ☐ Athletic performance tracking   ☐ Weight loss progress   ☐ Medical referral   ☐ Other: _______________

CLIENT CONSENT TO BODY COMPOSITION SCAN:

[Full consent text from your form]

Client Signature: _______________    Date: _______________
Staff Initials (for Triad DEXA use only): _______________

PHYSICIAN AUTHORIZATION:

(to be completed by referring provider — required under NC state regulations for DEXA scans)

• Referring Physician Name: _______________
• Practice/Facility Name: _______________
• Phone: _______________    Fax: _______________
• Email (if applicable): _______________

☐ I have reviewed the client’s request and medical information and authorize the DEXA body composition scan.
☐ This scan is medically appropriate and does not present a contraindication based on the client’s current condition.
☐ I understand that Triad DEXA is not responsible for medical interpretation of results.

Physician Signature: _______________    Date: _______________

Step 2: Save as PDF

Save your Word document as PDF: Triad-DEXA-Intake-Form.pdf

Step 1: Create Web Form in Adobe Sign

1. Log into Adobe Sign: https://secure.na1.adobesign.com
2. Navigate to: Home → Create → Web Form
3. Click Upload and select your PDF
4. Name the form: Triad DEXA – Patient Intake & Medical Clearance

Step 2: Configure Participant Routing

Signing Order: Sequential (Patient must sign first, then doctor receives email).

Step 3: Add Form Fields

CLIENT INFORMATION (Assigned to Patient)

MEDICAL BACKGROUND (Assigned to Patient)

CLIENT CONSENT (Assigned to Patient)

PHYSICIAN AUTHORIZATION (Assigned to Doctor)

WordPress → Adobe Sign Field Mapping

https://secure.na1.adobesign.com/public/esignWidget?wid=YOUR_WIDGET_ID&email={patient_email}&name={patient_name}

• {patient_email} → Patient’s WordPress email address
• {patient_name} → Patient’s WordPress display name (First + Last)

Adobe Sign Field Mapping

• URL parameter email → patient_email field
• URL parameter name → patient_full_name field

Enable Pre‑Fill in Adobe Sign

1. In the web form editor, click each field you want to pre‑fill
2. In field properties, check Pre‑fill
3. Enter the URL parameter name (e.g., email, name)
4. Save the form

Option 1: Conditional Logic in Adobe Sign

1. IF q1_pregnant = “Yes” THEN show error message and block submission
2. In editor, add Calculated Field or Validation Rule
3. Field: pregnancy_blocker
4. Rule: IF q1_pregnant == "Yes" THEN "ERROR: DEXA scans cannot be performed during pregnancy. Please contact us."
5. Prevent submission if rule triggers

Option 2: Doctor Review (Recommended)

Patient Completes Form → Notify Doctor

1. Form settings → Notifications
2. Enable: Notify next signer when previous signer completes
3. Customize email template:

Subject

New Patient Intake Ready for Review - {patient_full_name}

Body

Dr. [Doctor Name],

A new patient has completed their DEXA scan intake form and requires your medical review and approval.

Patient Name: {patient_full_name}
Patient Email: {patient_email}
Date Submitted: {completion_date}

CRITICAL ITEMS TO REVIEW:
- Pregnancy status (NC law requires rejection if pregnant)
- Medical implants or devices
- Current physician care
- Contraindications

Please click the link below to review the form and provide your digital signature if the patient is medically cleared:

[REVIEW AND SIGN BUTTON]

Once you sign, the patient will automatically be granted access to purchase DEXA scan packages on our website.

Thank you,
Triad DEXA Automated System

Doctor Signs → Notify Patient

Subject

Your DEXA Scan Has Been Approved!

Body

Hi {patient_full_name},

Great news! Your medical intake form has been reviewed and approved by our physician.

You are now cleared to purchase DEXA scan packages and schedule your appointment.

Next Steps:
1. Visit https://triaddexa.com/shop/ to browse scan packages
2. Complete your purchase
3. Visit https://triaddexa.com/book-your-scan/ to schedule your appointment

If you have any questions, please contact us at Info@TriadDEXA.com or call [phone].

We look forward to seeing you soon!

Triad DEXA Team
4361 Federal Drive, STE 180
Greensboro, NC 27410

Webhook Setup (Fires ONLY When Doctor Signs)

1. Account → Webhooks → Create Webhook

Configuration

• Name: Triad DEXA Doctor Approval
• Webhook URL: https://triaddexa.com/wp-json/tdx/v1/adobesign
• Events to Subscribe:
  • ✅ AGREEMENT_WORKFLOW_COMPLETED (fires when ALL signers complete)
  • ❌ AGREEMENT_SIGNED (do not use — fires after patient signs, too early!)
• Custom Headers:
  • Header Name: X-TDX-Secret
  • Header Value: [Copy from Triad DEXA → Gatekeeper settings]

Webhook Payload Example

{
  "event": "AGREEMENT_WORKFLOW_COMPLETED",
  "agreementStatus": "SIGNED",
  "participantSets": [
    {
      "memberInfos": [
        { "email": "patient@example.com", "name": "John Doe" }
      ]
    },
    {
      "memberInfos": [
        { "email": "doctor@triaddexa.com", "name": "Dr. Smith" }
      ]
    }
  ]
}

WordPress Plugin Logic

1. Receive webhook
2. Validate X-TDX-Secret
3. Check event == "AGREEMENT_WORKFLOW_COMPLETED"
4. Extract patient email from participantSets[0].memberInfos[0].email
5. Find WordPress user by email
6. Update user meta: tdx_intake_done = 1
7. Remove tdx_intake_pending flag
8. Grant shop access

Test 1: Patient Registration & Form Launch

• Patient registers at https://triaddexa.com/triad-dexa-scan-approval/
• WordPress account created
• Referral code saved (if provided)
• Patient auto‑logged in
• Page shows “Open Intake & Waiver Form” button
• Click button → Adobe Sign opens in new tab
• Patient email and name are pre‑filled

Test 2: Patient Completes Form

• All required fields enforced
• Pregnancy question answered
• Patient signature field works
• Date auto‑populated
• Form submits successfully
• Confirmation message shown to patient

Test 3: Doctor Notification

• Doctor receives email within 5 minutes
• Email contains patient name and details
• “Review and Sign” button works
• Form opens with patient’s completed responses visible
• Doctor can see pregnancy answer clearly

Test 4: Doctor Approval

• Doctor reviews form
• Doctor checks all 3 authorization checkboxes
• Doctor signature field works
• Date auto‑populated
• Form submits successfully

Test 5: Webhook Fires

• Adobe Sign webhook fires to WordPress
• WordPress receives webhook (check debug log)
• Secret validated successfully
• Patient email extracted correctly
• WordPress user found
• User meta updated: tdx_intake_done = 1
• Shop access granted

Test 6: Patient Can Purchase

• Patient visits https://triaddexa.com/shop/
• Shop is now accessible (not blocked)
• Patient can add product to cart
• Referral code applies at checkout (if provided)
• Order completes successfully
• Credits minted to patient account

Test 7: Patient Can Book

• Patient visits https://triaddexa.com/book-your-scan/
• Credit balance displayed correctly
• “Open Booking Calendar” button shown
• SimplyBook URL launches in new window
• Patient can schedule appointment
• Webhook fires and credit deducted

Issue: Patient Email Not Pre‑Filling

1. Check WordPress function tdx_generate_adobe_sign_url() includes email parameter
2. Verify Adobe Sign field patient_email has “Pre‑fill” enabled
3. Check URL parameter name matches exactly: email

Issue: Doctor Not Receiving Email

1. Check doctor’s email address in Adobe Sign form settings
2. Verify signing order: Patient = 1, Doctor = 2
3. Check doctor’s spam/junk folder
4. Test with different doctor email address
5. Verify Adobe Sign notifications are enabled in account settings

Issue: Webhook Not Firing

1. Use AGREEMENT_WORKFLOW_COMPLETED (not AGREEMENT_SIGNED)
2. Verify webhook URL: https://triaddexa.com/wp-json/tdx/v1/adobesign
3. Check webhook secret matches Gatekeeper settings
4. Review Adobe Sign webhook logs for errors
5. Test webhook with curl (see User Guide)

Issue: Patient Still Blocked After Doctor Signs

1. Verify agreement status is Completed in Adobe Sign
2. Check WordPress debug log for webhook receipt
3. Manually approve patient in Scan Manager as workaround
4. Verify patient email in Adobe Sign matches WordPress email exactly

Configure Adobe Sign Settings

1. WordPress Admin → Triad DEXA → Adobe Sign
2. Select Mode: Web Form (simple)
3. Enter Web Form URL (copy after publishing)
   Example: https://secure.na1.adobesign.com/public/esignWidget?wid=CBJ...
4. Save settings

Configure Gatekeeper Settings

1. WordPress Admin → Triad DEXA → Gatekeeper
2. Copy Webhook Secret (paste into Adobe Sign webhook header)
3. Configure Shop URLs (pages requiring approval):
   • /shop/
   • /checkout/
   • /cart/
4. Configure SimplyBook URL: https://triaddexa.simplybook.me/v2/
5. Configure Product → Credits Mapping:
   • 1‑Scan Package Product ID → 1 credit
   • 2‑Scan Package Product ID → 2 credits
   • 4‑Scan Package Product ID → 4 credits
   • 5‑Scan Package Product ID → 5 credits
6. Save settings

What You’ve Created

• ✅ Dual‑Signature Adobe Sign Form: Patient intake → Doctor approval (HIPAA‑aligned; legally required workflow)
• ✅ Webhook Integration: Fires only when doctor signs; grants shop access automatically
• ✅ Pre‑Fill Integration: Email & name auto‑populated for a seamless experience
• ✅ Email Notifications: Doctor notified after patient signs; patient notified after approval

The Complete Workflow

1. Patient registers → WordPress account created
2. Patient clicks button → Adobe Sign opens (pre‑filled)
3. Patient completes form and signs
4. Adobe Sign emails doctor
5. Doctor reviews pregnancy status and other items
6. Doctor signs to approve
7. Webhook fires to WordPress
8. WordPress grants shop access
9. Patient purchases scan package → credits minted
10. Patient books appointment → credit deducted

Every step is automated. No manual work except doctor’s review and approval.

• Adobe Sign Support: https://helpx.adobe.com/sign/help.html
• WordPress Plugin: Review documentation in plugin folder
• Technical Issues: Contact your development team

Document Version: 1.0  •  Last Updated: January 2025  •  Created By: PrometheanLink