Surprisingly, I don't have a big problem with the fact that the "form" is simply a pre-filled input area that I edited. I found it simple to understand and use, except for the intent of the "Voicemail" question: are they asking "Does your phone have voicemail capabilities?", or "May we leave a voicemail with your patient information in it?"
But the error condition AND its helpful messaging are atrocious for your average healthcare consumer.