Templates

Covid-19 Vaccination Card Upload

As the COVID-19 pandemic continues into 2022, the Centers for Disease Control and Prevention (CDC) along with healthcare providers around the globe have urged everyone who is eligible to receive a COVID-19 vaccination to do so. However, apart from a COVID-19 vaccination record card or a department of health COVID-19 vaccination form, there's no way to know who is unvaccinated and who is vaccinated. Keep yourself, your employees, and your customers safe from the threat of the novel coronavirus with the COVID-19 Vaccination Card Upload Form Template from Formsite. Whether you run a music venue, a restaurant, or a bookstore, this online proof of vaccination status form template makes it easy to ensure that everyone who enters your space is vaccinated. This vaccine card form collects all vital information employers and event planners need to ensure vaccination compliance. In addition to collecting personal details, such as name, address, age, and the like, this form also requires users to upload a picture of their vaccine card. This COVID-19 immunization record form makes it difficult for bad actors to present fake COVID-19 vaccination cards as the real thing, because it requires essential identifying information like lot number and date from the Moderna, Pfizer, and Johnson & Johnson vaccines. All Formsite form templates, including this one, are easy to edit and customize. They're also mobile friendly and can be shared via email or social media or embedded right into your website. Submitted form data is easy to download for use in other software apps, such as Excel, Google Sheets, and Google Docs for easy cross-referencing with ticket holder names and vaccine information.

COVID-19 Donation Form

Improve your fundraising efforts around the coronavirus pandemic, with Formsite's COVID-19 Donation Form Template. Online fundraising processes don't have to be complicated. Our donation form template makes it easy to collect data, build a donor list through your CRM, and increase donations. This user-friendly, customizable donation form works for for profit and nonprofit organizations, and there's no HTML or coding knowledge required! Automate your donation process by collecting contact information and credit card payment information, then complete payment processing quickly and efficiently so you can get back to helping your cause. This online donation form template sample collects all the information you need to fundraise and gather donations. From important donor information such as name and contact information to donation amount and credit card, PayPal, Stripe and other payment processors, this donation form makes it easy for potential donors to give. Our intuitive drag and drop editor makes it easy to customize this form on your fundraising page. Add and remove form fields. Select your own color scheme and fonts throughout the form and for your donate button, then seamlessly embed the donation form into your webpage, email it, or share it via social media for easy viewing with almost any mobile device, filled out, and then submitted. Easily export the data for reporting and analysis in a variety of formats, including Excel, Word, PDF, and Salesforce.

Refusal to Vaccinate Form

As different mandates emerge around COVID-19 immunizations from the U.S. Centers for Disease Control and Prevention, businesses, education institutions, and more, many organizations are finding they need a way to track and process medical exemptions, parental refusal, and personal refusal for those opting out of vaccines. Health care providers, pediatricians, HR professionals, and others can use Formsite's Refusal to Vaccinate Form Template to gather data securely and efficiently. This vaccine refusal form collects all essential information, including name, date of birth, contact information, the type of vaccine being refused (examples include: polio, Tdap or DTAP [diphtheria tetanus and pertussis], Varicella, chickenpox, hepatitis A, hepatitis B, meningitis, rotavirus, the novel coronavirus, HPV, MMR [measles-mumps-rubella], and pneumococcal), the reason for refusal, and an electronic signature section that also indicates the person in question has been given information regarding vaccine safety, the role of vaccines in public health and controlling outbreaks, etc. It also includes an editable vaccine information statement that refers patients to the AAP website (American Academy of Pediatrics at aap.org) and the Immunization Action Coalition at immunize.org for immunization information regarding protection against vaccine-preventable diseases. T With Formsite's import/export tools the data can be transferred to an external application for medical record updates. All Formsite forms can be embedded into any website, or the link sent via email or made accessible via social media for convenient access. The form can be viewed with tablets or smartphones, completed, and submitted via Formsite's secure technology. Enable optional notifications upon submission to initiate appropriate immunization requirement processes. This template can also be easily modified using our style tools and drag and drop editor to meet your specific needs and to match your branding. Check out the sample form below.

COVID-19 Vaccination Registration Form

Streamline how you gather customer, employee, student, or volunteer COVID vaccine information with this COVID-19 Vaccination Registration Form Template from Formsite. Useful to local health departments, pharmacies, pop-up vaccine locations, churches, educational institutions, and businesses, this vaccine registration form is also fully customizable with our drag and drop editor. This sample form template gathers all the data you need, including contact information, whether or not the individual is receiving a second dose or booster shot, whether they have a weakened immune system or pre-existing health conditions, or have had any experience or side effects or severe allergic reactions with past immunizations. Formsite's extensive form builder and style tools let you quickly and easily customize this template so it meets your exact needs. Once it's finished, it can be embedded right into your website, or the link emailed or posted to social media. Patients or employees with vaccine appointments can simply view the form with their mobile device, fill it out, and submit it prior to arrival. For walk-ins to your vaccination clinic, use text messaging to send the link upon arrival. All form data can be sent to other apps, too, including Excel, Word, PDF, Google Suite, and more, so you can send information to the CDC and your local health department.

COVID-19 Pre-Vaccination Checklist

COVID-19 vaccines are in high demand and many healthcare professionals are offering first doses, second doses, and boosters. The Covid-19 Pre-Vaccination Checklist from Formsite simplifies data collection for each vaccine recipient to ensure patient safety and confidentiality regarding the COVID-19 vaccine. Protect yourself, the healthcare providers you work with, and your practice from liability and keep patients safe with this quick and easy to use coronavirus screening checklist. This sample pre vaccination pre-vaccination checklist gathers vital information such as patient name, date of birth, contact information, whether the potential patient has received a first or second vaccine dose, as well as which type of previous dose they received. It also includes form fields that gather information about contraindications including anaphylaxis or any history of severe allergic reaction or side effects to immunizations, as well as current medicines, any immunosuppressive drugs or therapies, whether or not the individual feels sick today, or has a bleeding disorder or takes a blood thinner. There's even a question to cover the possibility of reactions to polyethylene glycol (PEG) or polysorbate. Tailor the form to gather any additional information you need, then embed it on your website, email the link, or post it to social media for easy viewing. No coding necessary! Mobile friendly, this HIPAA compliant screening tool minimizes errors and follows CDC and local health department best practices in gathering and securely storing pertinent patient vaccine information. All form data can be securely downloaded and used in other software applications, too.

COVID-19 Patient Intake Form

Health care professionals can more efficiently manage their COVID-19 patient intake process and data collection with this COVID-19 Patient Intake Form Template from Formsite. Quickly collect patient name, address, phone number, insurance information, preferred pharmacy, whether the patient has had a COVID-19 test or COVID-19 vaccine, past immunizations, current health conditions, pre-existing medical conditions that might lead to a weakened immune system, and more with a contactless workflow that follows U.S. Centers for Disease Control and Prevention (CDC) guidelines. Health care providers working in any size clinic will benefit from the quick and easy data collection process facilitated by this intake form. With Formsite's full suite of form builder tools, you can edit this sample form template, so it meets your needs. Once you're finished, you can embed the form right into your website, so patients and patient advocates can fill it out on their tablet or smartphone and submit it. That way, when they arrive at your site, any information related to COVID-19 testing or COVID-19 vaccines is at your fingertips. Enable optional notifications, so you know when a form has been submitted. You can also easily edit this patient intake form for streamlined, digital collection of vaccination records, from the Shingles vaccine to the flu shot, or tailor it to collect information related to a second dose or booster shot status. The options are limitless.

COVID-19 Vaccine Exemption Form

In compliance with recognized vaccine requirement guidelines, Formsite offers a COVID-19 Vaccine Exemption Form Template that facilitates expedited processes for medical contraindications or religious beliefs, recognized by the department of health. Here are the main features and benefits: Key Features: Facilitates Reasonable Accommodations: Recognizes medical contraindications or religious beliefs as valid reasons for vaccine exemptions. Secure & HIPAA Compliance Available: Ensures the safety and protection of all health information and personal data through encryption and SSL/TLS security measures. Versatile Deployment: Easily embed the form on your website, share via email, or post on social media for rapid access and submissions. Mobile-Friendly: Accessible via smartphones or tablets, enabling convenient form completion and submission from anywhere. Workflow Streamlining: Optional notifications alert staff upon submission, streamlining the healthcare provider's workflow. Benefits: Security & Compliance: Ensures secure transit and storage of sensitive data. Accessibility: Mobile-friendly design ensures ease of access and submission from any device. Time Efficiency: Quick and simple customization using drag and drop tools streamlines the form creation process. Versatility: Not limited to COVID-19; the form can serve as a foundation for various other vaccine exemption requests. Data Collection: Gathers crucial medical exemption details such as name, date of birth, contact information, contraindications, history of severe allergic reactions, and other medical conditions.   Formsite's COVID-19 Vaccine Exemption Form Template offers a comprehensive solution that prioritizes security, ease of use, and adaptability, catering to the diverse needs of healthcare providers and patients alike. This versatile template serves as an ideal starting point not only for COVID-19 vaccine exemptions but also for various other immunization exemption requests, streamlining the process and ensuring the collection of essential medical information necessary for exemptions.

COVID-19 Vaccine Consent Form

Cover any potential for liability, while streamlining data collection with Formsite’s COVID-19 Vaccine Consent Form. In addition to getting a patient’s informed consent prior to vaccine administration of either the first or second dose of the coronavirus vaccine, this form template allows healthcare providers, vaccination appointment coordinators, and other vaccination providers to gather exactly the data they need in an easy to fill out, mobile friendly form. Gathering data and getting the information and permission you need to give a vaccine has never been easier. This consent form can double as a fact sheet, because it includes up to date information about FDA approval, emergency use authorization (EUA), each of the COVID-19 vaccines, including Pfizer-Biontech, Moderna, and Johnson & Johnson, and eligibility information. Information collected includes name, contact information and phone number, date of birth, ethnicity (e.g. American Indian or Alaska Native, African American, Native Hawaiian or Pacific Islander, etc.), type of vaccine that will be administered (e.g. Pfizer, Moderna, Janssen), whether or not the person has a weakened immune system or is immunocompromised, as well as fields that ask about any severe allergic reaction or anaphylaxis responses to other immunizations, medications being taken (e.g. blood thinner), whether or not the person seeking the COVID-29 vaccine is pregnant or breastfeeding, and more. If you need to gather different information, just use our drag and drop editor. The form is completely customizable, and once you're through you can embed it right into your website or send it out over email. No coding required! Anyone wishing to get the COVID-19 vaccine can view the form with their smartphone or mobile device, fill it out, and submit it. That way, when they come in for their scheduled appointment all pertinent information is at your fingertips. Enable optional notifications so you know when a COVID-19 vaccine consent form has been submitted. You can also export the data to an external application for reporting or processing.

Course Withdrawal Due to COVID-19 Form

Easily manage withdrawal requests impacted by the COVID-19 pandemic with Formsite's user-friendly Class Withdrawal Due to COVID-19 Form Template. This tool streamlines the withdrawal process, providing swift support to students and enabling efficient updates to enrollment records for academic advisors and the registrar's office. Key Benefits: Secure Data Collection: Formsite employs cutting-edge data encryption and secure connections (SSL / HTTPS), ensuring the safe and secure collection of withdrawal information. Comprehensive Form Fields: The sample withdrawal form includes crucial school messaging about withdrawal policies, deadlines, post-COVID enrollment status, dropped course numbers, titles, final grades, and student athlete scholarship notes. Signature Sections: The form accommodates electronic student, advisor, instructor, and administrator signatures, facilitating a complete record of approvals and authorizations. Mobile Accessibility: Accessible on mobile devices, the form allows students, including graduate and international students, to easily fill in and submit the withdrawal request by the specified deadline. Customizable: Utilize Formsite's robust form builder tools to tailor the form to your university registrar's requirements. The drag-and-drop editor makes customization a breeze. How It Works: Formsite's Class Withdrawal Due to COVID-19 Form Template is designed to streamline the withdrawal process, ensuring both students and administrative staff can efficiently manage withdrawal requests affected by the pandemic. The template includes fields for essential withdrawal information, allowing for a quick and thorough completion process. The mobile-friendly design ensures accessibility for all students, providing ease of use on various devices. Simple Customization: With Formsite's user-friendly drag-and-drop editor, customizing the withdrawal form to suit your university's unique needs is straightforward. Review the template and easily embed the customized form into your university's website for seamless access.

COVID-19 Self Declaration Form

Securely and efficiently collect COVID 19-related confidential, personnel information from employees with this COVID-19 Self Declaration Form Template from Formsite. This self-declaration form can help minimize the spread of the COVID-19 virus at your organization, and help monitor personal circumstances that may lead to infection. All Formsite forms and surveys are protected with our SSL to keep data secure in transit and in storage, so employees can be certain their personal information is secure. This sample form template collects all the self-declaration data you need, like full name, date of birth, phone number, number of household members, transportation type (personal vehicle, rail or other form of public transport, flight number for air travel, etc.). Need to gather different information? Easily add and remove fields using our drag and drop editor. Include short answer, long answer, drop downs, checkboxes, and calendars for quick data entry and to minimize entry errors. This, and all Formsite forms, can be easily embedded in a website or shared via email. Form users can securely view this mobile friendly COVID-19 Self Declaration Form Template, fill it out, and submit it right from their own mobile device. All form data can be exported, too, for use in other applications.

COVID-19 Questionnaire Form

Ensure your company follows guidance from local public health authorities and the Centers for Disease Control and Prevention (CDC) by tracking possible employee COVID-19 cases with this easy coronavirus screening questionnaire. The COVID-19 Questionnaire Form Template from Formsite can help minimize the risk of exposure to COVID-19 at your organization, so you can protect your workforce and your bottom line. This COVID-19 screening questionnaire, like all Formsite forms and surveys, can be easily embedded directly into your website or shared via email. Employees can securely fill out the screening questions and submit the form from their own smartphone or tablet. All form data, including health information and personal data, will remain confidential and protected while in transit and during storage. Formsite forms include easy section navigation and data entry. This sample form includes basic screening questions such as: “Have you had the COVID-19 vaccine?”, “Are you experiencing any of the following symptoms: sore throat, shortness of breath, runny nose, difficulty breathing, loss of taste or smell, body aches?”, and “Have you been in close contact with anyone with a COVID-positive test result?” You can add your own questions and change the look of this sample form template with our intuitive drag and drop editor. Once you're happy with your questionnaire, enable optional notifications so you know when a form has been submitted and whether an employee has denoted a self-quarantine status.

COVID-19 Exposure Report Form

Use the COVID-19 Exposure Report Form Template from Formsite at your workplace to easily and securely collect the critical data needed to track potential coronavirus exposure incidents. For human resources professionals and others who are responsible for COVID-19 exposure reporting requirements, this incident report form makes it easy to stay apprised of potential COVID-19 cases at your job sites or workplace. This standard COVID-19 incident report can be tailored to your exact needs, then embedded right on your website, emailed, or posted on social media. Mobile friendly, this Formsite incident report form can be filled out on and submitted from any tablet or smartphone for a convenient, safe contact tracing process. Enable notifications to alert you when an incident report has been submitted so you can disseminate CDC COVID-19 health care protocols to affected individuals. This sample COVID-19 reporting form collects all the information you need to track exposure incidents, including: name and phone number, suspected date of exposure, date of COVID-19 test, COVID-19 test results, COVID-19 symptoms (e.g. shortness of breath, fever, loss of taste or smell) and whether the employee in question has been in close contact with anyone COVID positive. All Formsite forms use the latest technology to offer secure connections (SSL / HTTPS) during entry and storage, as well as secure options for viewing and sharing the data. Users can be confident their sensitive information is safe.

COVID-19 Daily Health Check Form

Managing employee health amidst COVID-19 concerns is made simple with the COVID-19 Daily Health Check Form Template offered by Formsite. This tool is specifically designed to streamline adherence to CDC guidance and local health department requirements, effectively minimizing the risk of COVID outbreaks within your organization. Key Benefits: Effortless Daily Health Assessment: The form is structured to make it easy for organizations to conduct daily health assessments. It efficiently collects crucial information on employees' COVID-19 vaccine status, test results, symptoms, and potential contact with positive cases. Customizable Questionnaire: Tailor the questionnaire to your organization's specific needs using the intuitive drag-and-drop editor. Adapt the questions to suit your unique requirements without any coding knowledge necessary. Seamless Integration and Accessibility: After customization, embed the form directly on your website or distribute it swiftly via email. Employees can conveniently fill it out using any mobile device before each shift. Optional Notifications: Stay informed by enabling optional Notification emails. Receive alerts upon form submissions and get alerted if any COVID symptoms are reported, facilitating immediate action and response. Data Security and Privacy: Rest assured that all information gathered is kept entirely secure during transit and encrypted when stored. This ensures employees can confidently share their personal healthcare data without any compromise to their privacy.   This comprehensive and easy-to-use COVID-19 Daily Health Check Form Template is a valuable tool for businesses aiming to safeguard employee health and meet compliance with health guidelines, all while mitigating the risk of liability. The flexibility, security, and accessibility it offers make it an indispensable asset in the ongoing battle against COVID-19.