Immunization History Form
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Immunization History Form
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Sign up and start customizing in minutes.
Start with the Immunization History Form template and tailor it to your practice. It includes 12 editable fields across 2 pages. Included questions: Full Name, Date of Birth, Childhood Vaccinations, Adult Vaccinations. The full field list below shows what you will get when you add this template to your account.
Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.
What's included
- Full Name
- Date of Birth
- Childhood Vaccinations
- Adult Vaccinations
- Influenza Vaccination History
- COVID-19 Vaccination Series
- Adverse Reactions to Vaccines
- Titer Results / Immunity Evidence
- Exemption Documentation
- Next Booster Due Date
- Administering Provider
- Patient/Guardian Signature
Who uses this template
- Primary care and pediatric well-visit immunization reviews
- School and employment vaccination compliance verification
- Travel medicine pre-departure immunization planning
- Occupational health onboarding and annual compliance
All form fields
12 fields across 2 pages. Customize any field after signing up.
How to use the Immunization History Form
Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Immunization History Form from the template library. Review the included questions, customize your fields, and preview the form before sharing it.
Setup steps
- 1Choose the template. Find the Immunization History Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 12 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
How does Formisoft protect responses?
Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.
Does this template work on mobile devices?
Yes. The Immunization History Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the Immunization History Form for your practice. Set up in minutes.
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