Multi-Step Form Process
Step 1 - User Information
Full Name
Phone Number
Email
I confirm my data is accurate and consent to the use of my data under DPA.
Next Step
Step 2 - Agency and Report Type
Select Agency:
Agency A
Agency B
Select Report Type:
Report A
Report B
Next Step
Step 3 - Appointment Schedule
Select Appointment Date:
Next Step
Step 4 - Preview & Submit
Submit