Add New Online Forms (ADS): How do I create a new CP Online Form™ to collect payment using the Auto-Debit System®?

CP Online Form Settings

Form Name

Using characters A-Z, a-z, and 0-9. Choose a name that identifies the CP Online Form™ so it can be easily found when you have a large list of forms.

Form Description

Enter a description for the CP Online Form™. What you enter here will be displayed on the CP Online Form™ and Email Receipt as well as substituted for the Drip-Ed™ Variable %FormDesc%. Ex: Monthly Website Membership. If left blank, no description will be displayed.

Form Settings

Form Type (choose from the following)

Lead Generation Landing Page Form (DES): Select to create Landing Pages. Using the Drip-Education System to assign email campaigns makes this a powerful tool for generating leads online.

Static Display Landing Page (DES): No information is collected at all. Use this choice to display the page only. Great if you want to create a custom thank you page

Credit Card & Bank EFT Payment Form: Uses the Auto-Debit System® to offer both credit/debit and bank EFT payment choices on your form.

Credit Card Payment Form: Uses the Auto-Debit System® to offer credit/debit payments only. This is recommended if you are selling a physical product.

Bank EFT Payment Form: Uses the Auto-Debit System® to offer bank EFT payments only. If you are selling a physical product, we recommend you wait at least one week before shipping it to ensure the EFT does not get returned for insufficient funds.

Payment Choices

Set Payment Amount : Designate the dollar amount the patient will pay for your product or services.

Custom Payment Amount or Schedule: Allow customers to enter their own payment amount.

Log in Options

No Login Required - If the customer uses the same email address each time they complete a CP Online Form™, their patient record will be updated without creating a new patient record. Otherwise, a New Patient Record will be created. (recommended)

(optional) Show Login Button - Verify CP Customer ID - Use this setting if you want a Returning Customer to LOG IN (using their Customer ID) so that the CP Online Form™ gets pre-populated with their Patient Record data. They log in with a CP Customer ID (which is included in the receipt that gets emailed to them) and their email address. You can locate their Customer ID in the Patient Record as well.

(optional) Show Login Button - Verify TPS ID - Use this setting if you want a Returning Customer to LOG IN (using their TPS/EHR ID) so that the CP Online Form™ gets pre-populated with their Patient Record data. They log in with their TPS and their email address.

Form Mode

ADS-Mode Live: Uses your active merchant account to process payments. Select this option when you are ready to go live with your form. You may turn this back to test mode at any time

Test Mode: Uses a test merchant account and requires the use of test credit card numbers (see Auto-Debit System® Quick Start Guide for test card numbers.) Recommended to run test transaction on the form before providing the form to patients.

Form Submit Button

Enter what you want "Submit" button to say. For example, 'Subscribe Now' for memberships or 'Click To Pay'.

Status

Active: Turns ON the CP Online Form™.

Inactive: Turns OFF the CP Online Form™. If you try to access the CP Online Form™ while it's Inactive, you will be redirected to an error page.

[Click Save/Next] to save your changes and move on to the next step.

Auto-Debit System Settings

Assign Transactions to Auto-Debit Group

(Optional) Select an Auto-Debit Group™ the patient will be assigned to when the form is completed 

Initial Payment Amount

Enter the $ amount for the initial payment. This payment is processed as soon as the form is submitted.

If you leave it blank or enter 0, the CP Online Form™ will turn into a Billing Vault Form, where its only function is to capture the billing information and not charge the patient. Unless using the Recurring Payment Settings.

Load Gift Card

[NO] Do NOT Load Gift Card

[Yes] Load Gift Card - this is for Gift Card Purchases only. Only compatible with our in house Gift Card program.

Recurring Payment Settings

Auto-Debit Frequency

None: select this option if there are no recurring payments for the products/services on this form.

Click the drop down to choose from the recurring payment increments from 1 week to 1 year.

Auto-Debit Amount

Enter the $ amount for the recurring payment.

Number of Auto-Debit Payments

Enter the total number of recurring payments, or check the indefinite box to set them up indefinitely.

Multi-Item Quantity Settings

Include Quantity Selector

No: Select this if you are not selling products or services that your clients can purchase multiple.

Yes: Select this option if you would like your clients to purchase multiple.

Quantity Label

Enter the label for your Quantity Selector.
Example: If you are selling supplements, "Total Supplements"
If you are selling memberships, "Number of Memberships"

Quantity Minimum

Enter the minimum number a client can purchase.

Quantity Maximum

Enter the maximum number a client can purchase.

Quantity Multiplier Value

Enter the Quantity Multiplier Value you wish to use. For example, if you want to increase the price by 15% for each quantity selected, enter 0.15. The default value is 1, which increases the price by 100% for each increment.

Apply Quantity Multiplier To

Initial Fee Only: Applies the multiplier only to the upfront cost, keeping the recurring Auto-Debit Fee at a flat rate.
Recurring Only: Keeps the Initial Fee as a one-time flat rate, while multiplying the recurring Auto-Debit Fee by the selected quantity.
Both Initial & Auto-Debit Fees: Applies the quantity multiplier to both the Initial Fee and the Auto-Debit Fee.

[Click Save/Next] to save your changes and move on to the next step.

Standard & Custom Form Inputs

Not Included

Input will not be included in the CP Online Form™

Included

Input will be included on the CP Online Form™ and will be Optional.

Required

Input will be included in the CP Online Form™ and is Required to submit the form.

[Click Save/Next] to save your changes and move on to the next step.

Patient Assignment Settings

Assign Patient To Provider

Select the provider you want the customer assigned to. If you select an associate member to assign the customer to, their account must remain active for the CP Online Form™ to function.

Assign Patient To Label (success)

Select the Label you want to be assigned to the customer if the transaction is successful.

Assign Patient To Label (failure)

Select the Label you want to be assigned to the customer if the transaction fails.

Assign Patient To Group (success)

Select the Group you want the patient assigned to if the transaction is successful. This is optional.

Assign Patient To Group (failure)

Select the Group you want the patient assigned to if the transaction fails. This is optional.

Drip-Education® Campaigns

Assign Patient to Campaign (success)

Select the Drip-Ed™ Campaign you want to be assigned to the customer if the transaction is successful. This is optional.

Assign Patient to Campaign (failure)

Select the Drip-Ed™ Campaign you want to be assigned to the customer if the transaction fails. This is optional.

[Click Save/Next] to save your changes and move on to the next step.

Privacy Policy

The CP Online Form™ Privacy Policy is where you indicate your company's Privacy Policy. The link to the Privacy Policy will be placed at the bottom of the CP Online Forms™ and will open a pop-up window. Here, enter your policies, or at a minimum, use the pre-loaded content and delete the text in red font confirming you've read and agreed.

Terms Of Use

The CP Online Form™ Terms of Use is where you indicate your company's Terms of Use. The link Terms of Use will be placed at the bottom of the CP Online Forms™ and will open a pop-up window. Your merchant provider REQUIRES this link on ALL online forms. Here enter your Terms of Use, or at a minimum, use the pre-loaded content and delete the text in red font confirming you've read and agreed.

Return Policy

The CP Online Form™ Return Policy is where you indicate your company's Return Policy. The link Return Policy will be placed at the bottom of the gateway and will open a pop-up window. Your merchant provider REQUIRES this link on ALL online forms. Here, enter your Return Policy and remove the red font confirming you've read and agreed.

[Click Save/Next] to save your changes and move on to the next step.

Receipt Emailed

Email Receipt: Sends an emailed receipt to the client.

No Email Receipt: Does not send an emailed receipt.

Reply-To-Email

%Email% : This option will use the account administrator's email on file.

You can remove the %Email% variable and enter a custom email address for the Reply-to. This is used when clients reply to an emailed receipt.

Results Page

Default Receipt Page: This will redirect to a receipt page that uses the Default Receipt Page & Email Header and Footer.

Custom Results URL: This option will take the client to the specified webpage.

Custom Results Destination URL

Enter the URL you want to forward the results of the CP Online Form™. Then, Select POST or GET for the method you want the form to use when redirecting to the Custom Results Destination URL.

POST: Used for updates, sends data securely in the request body and is perfect for forms.

GET: Use this for fetching data and appending parameters in the URL, ideal for searches

Random Value Generator (optional)

You may have need of a randomly generated value created for your Custom Result URL. For example, if you need an Account Name or Password generated, this will do it

You can then have your Custom Results URL so something within the value - such as generating an account on your website. Then you can easily pass this value to the customer in the form of creating a Drip-Ed™ Campaign that contains %RandomValue% within it.

Select the length of the value you wish to create.

[Click Save/Next] to save your changes and move on to the next step.

Direct Link

This is the link to this CP Online Form™. You can copy the link and paste it into your browser to open the CP Online Form™.

To preview your form: Click [Test].
To copy the link: Click [Copy Link].

Link tracker:

(For members use Drip-Ed) The Drip-Ed Link Trackers™ allows you to better track your stats. By assigning this CP Online Form™ to a Drip-Ed Link Tracker™, you will be able to see who clicks the links and more. Then use its Drip-Ed™ Variable in your email campaigns as links to the link tracker.

To generate tracker access, click on the [+ Click to Generate Link] button.