formisoft

Immunization History Form

Asks about childhood vaccinations, adult vaccinations, and influenza vaccination history. Built for primary care and pediatric well-visit immunization reviews.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Conditions checklist
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Your practice

Immunization History Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • 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

Formisoft for Pediatrics

What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Date of BirthDate
  3. Childhood VaccinationsConditions
  4. Adult VaccinationsConditions
  5. Influenza Vaccination HistoryConditions

Page 2 · Additional details

  1. Adverse Reactions to VaccinesConditions
  2. Titer Results / Immunity EvidenceLong Text
  3. Exemption DocumentationLong Text
  4. Next Booster Due DateDate
  5. Administering ProviderText

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Immunization History Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Immunization History Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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