Consent Form for COVID-19 Vaccination
The free online form can be used to gather informed consent from patients receiving Pfizer, Novavax, or Moderna COVID-19 vaccines. This universal template can also serve as the basis for a COVID booster consent form. Easily adapt the vaccine consent form template to meet your medical practice. Edit consent points, add more fields or controls to gather patient medical history, vaccination records, and more. Then, share the form directly with your patients, display it on the office tablet or computer, or embed it on your website for seamless access and convenience.
Structure and logic of the form
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The calendar start view is set up to show the years of the decade. Thus, patients can quickly find the required date by year, then select the month and date without endless scrolling through the calendar.
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To make sure patients are over 18 years old, the dates within the last 18 years are disabled. Specify the available date range in the calendar to efficiently schedule appointments, follow-up consultations, or treatment plans, track vaccination expiry dates, and more.
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The Phone, Medicare Number and Individual Health Identifier (IHI) fields accept only digits to prevent input errors. It's done with Masked Text field type. Use it to specify a particular format and ensure accurate data collection for patient details, including social security numbers, health insurance policy numbers, and medical IDs.
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The email fields only accept data that matches the specified pattern to ensure users enter valid emails. Patterns are an alternative to the Masked Text field to restrict user input. Choose from predefined patterns or create your own to verify patient information.
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Patients must agree to all the listed points in order to submit consent for medical intervention; otherwise, they will encounter an error. It is done by adding custom validation to the field. Add custom validation to a field or the entire form to confirm the vaccination period, require medical files to be uploaded, or verify data accuracy.
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Patients confirm the accuracy of the data they have provided with a signature.