Documents & Forms
Microsoft 365 & SharePoint Tools
Classic SharePoint Tools

COVID-19 Vaccination Registration Form

Use our free online form to register patients for COVID-19 vaccination and get their consent for medical intervention. This free template includes patient information, insurance, health metrics, and the option to choose the vaccine brand (Pfizer, Novavax, or Moderna). The template is easily customizable, so you can adapt it to meet the specific requirements of your medical practice.

Use this template

Structure and logic of the form

  • The form is broken down into steps using the Wizard container. This enhances the user experience as patients can navigate between form sections easily and see their progress through the form.

  • 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.

  • 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.

  • To avoid errors, future dates and dates preceding the pandemic in the Immunization Date and Positive test date calendars are disabled. You can specify the available date range in the calendar or disable specific dates, such as weekends and holidays.

  • The phone fields accept only 11-digit numbers 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.

  • 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.

  • When patients answer 'yes' to any question, additional fields appear to collect more details. It's done with a JavaScript function and helps keep the form neat and user-friendly. In the same way, you can deactivate fields, make them mandatory, show or hide containers, change element styling, and more. Find code examples in the Manage fields article.

  • Patients confirm the accuracy of the data they have provided with a signature.