ILLUSTRATIVE EXAMPLE: Fictional data, not a live customer scan.

# Form privacy report: Example Clinic

- **Site:** Example Clinic (https://example.org/)
- **Generated:** October 11, 2026 by Demo reviewer
- **Form Marshal:** 0.6.2
- **Enforcement:** Health forms: Block. Personal-information forms: Flag only.
- **Last full scan:** October 11, 2026
- **Forms:** 6 in all. PHI 2, screening instruments 1, PII 2, clear 1, not scanned 0.
- **Need action:** 2 flagged forms are neither blocked nor covered by an exception or dismissal.

## Forms

### Patient intake (#1)

- **Status:** PHI (Critical). Blocked on the site
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Why:**
  - Field 3 "Describe your symptoms" label matches "symptom": health context (0.85)
  - Field 1 "Full name" has field type "name": name (0.90)
  - Field 2 "Date of birth" label matches "date of birth": date tied to a person (0.90)
- **Placed on:**
  - Patient intake demo page (https://example.org/patient-intake-demo-page/)

### Follow-up appointment request with a temporary exception (#5)

- **Status:** PHI (High). Exception until October 25, 2026
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Why:**
  - Field 2 "Current medications and symptoms" label matches "symptom": health context (0.85)
  - Field 1 "Patient name" has field type "name": name (0.90)
  - Field 2 "Current medications and symptoms" label matches "medication": health context (0.85)
- **Placed on:**
  - Follow-up appointment request with a temporary exception demo page (https://example.org/follow-up-appointment-request-with-a-temporary-exception-demo-page/)

### PHQ-9 depression screening (#2)

- **Status:** PHI (screening instrument) (Critical). Blocked on the site
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Why:**
  - The form title or description names the screening instrument "PHQ"
  - The form title matches "depression" (0.80)
  - 2 fields match screening instrument items
- **Placed on:**
  - PHQ-9 depression screening demo page (https://example.org/phq-9-depression-screening-demo-page/)

### Contact request (#3)

- **Status:** PII (Moderate)
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Why:**
  - Field 1 "Your name" has field type "name": name (0.90)
  - Field 2 "Email address" has field type "email": email address (0.90)
  - Field 2 "Email address" label matches "email": email address (0.85)
- **Placed on:**
  - Contact request demo page (https://example.org/contact-request-demo-page/)

### Website feedback (#6)

- **Status:** PII (Moderate)
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Why:**
  - Field 1 "Website feedback" label matches "website": web address (0.60)
- **Placed on:** No pages found

### Website color poll (#4)

- **Status:** Clear (Low)
- **Entries:** 0 stored. Kept forever.
- **Data leaves by:** None found
- **Last scanned:** October 11, 2026
- **Placed on:**
  - Website color poll demo page (https://example.org/website-color-poll-demo-page/)

_Form Marshal is a control, not a compliance guarantee. This report is built from findings about form fields, settings, and placement; it contains no form entries._