Of course. I totally should’ve expected that! 
Okay, here’s the template we’ve been testing:
<div id="appointment_request">
<p class="close_js"><a href="#" class="lbAction" rel="deactivate">Close</a></p>
{exp:freeform:form form_name="appointment_request" required="name|from|address|phone|weekday|weekday2|time|time2"
notify="13606665254@efaxsend.com|battleground@gentle1.com|eniemi@gmail.com|15308845258@efaxsend.com" template="appointment_request"}
<h2>Appointment Request Form</h2>
<p>Thanks for your interest in Gentle Dental Battle Ground. Please provide the information below and our friendly staff will contact you to finalize your appointment. All fields are required.</p>
{embed=lightboxes/ar_form}
{/exp:freeform:form}
</div>
Here’s the form that’s embedded per above:
<input type="hidden" name="location" value="segment_3" />
<input type="hidden" name="seg3" value="{segment_3}" />
<p><label for="name">Full name:</label><br />
<input type="text" id="name" name="name" size="40" maxlength="35" value="" /></p>
<p><label for="address">Address:</label><br />
<input type="text" id="address" name="address" size="40" value="" /></p>
<p><label for="phone">Phone:</label><br />
<input type="text" id="phone" name="phone" size="40" value="" /></p>
<p><label for="from">Email:</label><br />
<input type="text" name="from" size="40" /></p>
<p><label for="weekday">Preferred Day 1:</label>
<select name="weekday[]" id="weekday_menu">
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
</select></p>
<p><label for="time">Preferred Time 1:</label>
<select name="time[]" id="time_menu">
<option value="Morning">Morning</option>
<option value="Lunchtime">Lunchtime</option>
<option value="Afternoon">Afternoon</option>
<option value="Evening">Evening</option>
</select></p>
<p><label for="weekday2">Preferred Day 2:</label>
<select name="weekday2[]" id="weekday_menu2">
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
</select></p>
<p><label for="time2">Preferred Time 2:</label>
<select name="time2[]" id="time_menu2">
<option value="Morning">Morning</option>
<option value="Lunchtime">Lunchtime</option>
<option value="Afternoon">Afternoon</option>
<option value="Evening">Evening</option>
</select></p>
<p><input type="checkbox" name="has_been_to_office" value="Has been to office before">I have been to a Gentle Dental office before.</p>
<p><input name="submit" type='submit' value='Submit Form' /></p>
And here’s the email notification template:
Entry Date: {entry_date}
{all_custom_fields}
-----------------
Staff Use Only
-----------------
Contact this patient today to schedule an appointment. Fill out the appropriate fields below and hand in to your Office Manager before you leave.
Staff Member Name: ________________________________________
Made an appointment on: ________________________________________
Left a message on: ________________________________________ and follow up is needed.
Patient was contacted but chose not to make an appointment: _______________
