formisoft

Vaccination Consent Form

Asks about vaccine(s) requested, allergies to vaccine components, and currently pregnant or immunocompromised. Built for screening patients for vaccine contraindications before administration.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Conditions checklist
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Your practice

Vaccination Consent Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Screening patients for vaccine contraindications before administration
  • Documenting informed consent for flu, COVID-19, or routine immunizations
  • Capturing guardian authorization for pediatric vaccinations
  • Meeting CDC and state requirements for immunization record-keeping

Formisoft for Pediatrics

What's inside

Before you publish: Add your practice-approved consent wording before publishing.

Page 1 · Your information

  1. Patient Full NameText · Required
  2. Date of BirthDate
  3. Vaccine(s) RequestedConditions
  4. Allergies to Vaccine ComponentsConditions
  5. Currently Pregnant or ImmunocompromisedLong Text

Page 2 · Additional details

  1. Previous Adverse Reaction to VaccinesConditions
  2. VIS Received and ReviewedLong Text
  3. Guardian Name (if minor)Text
  4. Consent to VaccinateConditions
  5. Patient or Guardian SignatureE-Signature

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 Vaccination Consent 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

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.

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.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. 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.

Yes. The Vaccination Consent Form works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Vaccination Consent Form to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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