Yes you can do it. Please follow the steps to achieve this.
1.Create mobile app
2.Create a new page
3.From where you can see the components and you can design your form.
4.Based on the source you can initiate the connector configuration
5.Then go to model and define your design model.
6.Once completed go to the source and create the source mapping.
7.Then go to the page and bind the model to your data binding to the respective controls
8.You can initiate the save from using the button component via onPress event.
9.Select the smart code and go to Save model method to call your model configuration.
10.In the success block you can use the firebase notification method to configure the specific date which you will fill in the form.
Please go with the below documents and tutorials to achieve this.