COVID-19 Vaccine Consent Template

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.