Psychiatry & Psychology
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PREFERRED GENDER:[select name="gender" value="Male|Female"][text name="variable_b2" default=""]


Family History:
Family of Origin:
Client reported [conditional field="gender" condition="(gender).is('Female')"]she [/conditional][conditional field="gender" condition="(gender).is('Male')"]he [/conditional] was born and raised in
[text name="born" default="sample text"]
by [conditional field="gender" condition="(gender).is('Female')"]her[/conditional][conditional field="gender" condition="(gender).is('Male')"]his[/conditional]
[select name="raised by" value="parents|mother|father"]. Client indicated
[conditional field="gender" condition="(gender).is('Female')"] she [/conditional][conditional field="gender" condition="(gender).is('Male')"] he [/conditional]lived with [conditional field="gender" condition="(gender).is('Female')"]her[/conditional][conditional field="gender" condition="(gender).is('Male')"]his[/conditional]
[text name="lived with" default="sample text"]while
[conditional field="gender" condition="(gender).is('Female')"] she [/conditional][conditional field="gender" condition="(gender).is('Male')"] he [/conditional] was growing up.
Overall, Client described [conditional field="gender" condition="(gender).is('Female')"]her[/conditional][conditional field="gender" condition="(gender).is('Male')"]his[/conditional] childhood as “
[text name="childhood" default="sample text"].” Client reported family attitudes, values, and messages about sexuality were “
[text name="familysexvalues" default="sample text"].”

Father: Client’s father,
[text name="fatherage" default="sample text"],
[select name="fatherjob" value="works as a|retired from working as a|was unemployed"] . Client described
[conditional field="gender" condition="(gender).is('Female')"]her[/conditional][conditional field="gender" condition="(gender).is('Male')"]his[/conditional] relationship with
[conditional field="gender" condition="(gender).is('Female')"]her[/conditional][conditional field="gender" condition="(gender).is('Male')"]his[/conditional] father as “
[text name="variable_1" default="sample text"].”
PREFERRED GENDER:


Family History:
Family of Origin:
Client reported was born and raised in

by
. Client indicated
lived with
while
was growing up.
Overall, Client described childhood as “
.” Client reported family attitudes, values, and messages about sexuality were “
.”

Father: Client’s father,
,
. Client described
relationship with
father as “
.”

Result - Copy and paste this output:
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