COVID-19 Patient Intake Template

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.