Healthcare Form Templates

COVID-19 Donation Form

Improve your fundraising efforts around the coronavirus pandemic, with Formsite's COVID-19 Donation Form Template. Online fundraising processes don't have to be complicated. Our donation form template makes it easy to collect data, build a donor list through your CRM, and increase donations. This user-friendly, customizable donation form works for for profit and nonprofit organizations, and there's no HTML or coding knowledge required! Automate your donation process by collecting contact information and credit card payment information, then complete payment processing quickly and efficiently so you can get back to helping your cause. This online donation form template sample collects all the information you need to fundraise and gather donations. From important donor information such as name and contact information to donation amount and credit card, PayPal, Stripe and other payment processors, this donation form makes it easy for potential donors to give. Our intuitive drag and drop editor makes it easy to customize this form on your fundraising page. Add and remove form fields. Select your own color scheme and fonts throughout the form and for your donate button, then seamlessly embed the donation form into your webpage, email it, or share it via social media for easy viewing with almost any mobile device, filled out, and then submitted. Easily export the data for reporting and analysis in a variety of formats, including Excel, Word, PDF, and Salesforce.

Refusal to Vaccinate Form

As different mandates emerge around COVID-19 immunizations from the U.S. Centers for Disease Control and Prevention, businesses, education institutions, and more, many organizations are finding they need a way to track and process medical exemptions, parental refusal, and personal refusal for those opting out of vaccines. Health care providers, pediatricians, HR professionals, and others can use Formsite's Refusal to Vaccinate Form Template to gather data securely and efficiently. This vaccine refusal form collects all essential information, including name, date of birth, contact information, the type of vaccine being refused (examples include: polio, Tdap or DTAP [diphtheria tetanus and pertussis], Varicella, chickenpox, hepatitis A, hepatitis B, meningitis, rotavirus, the novel coronavirus, HPV, MMR [measles-mumps-rubella], and pneumococcal), the reason for refusal, and an electronic signature section that also indicates the person in question has been given information regarding vaccine safety, the role of vaccines in public health and controlling outbreaks, etc. It also includes an editable vaccine information statement that refers patients to the AAP website (American Academy of Pediatrics at aap.org) and the Immunization Action Coalition at immunize.org for immunization information regarding protection against vaccine-preventable diseases. T With Formsite's import/export tools the data can be transferred to an external application for medical record updates. All Formsite forms can be embedded into any website, or the link sent via email or made accessible via social media for convenient access. The form can be viewed with tablets or smartphones, completed, and submitted via Formsite's secure technology. Enable optional notifications upon submission to initiate appropriate immunization requirement processes. This template can also be easily modified using our style tools and drag and drop editor to meet your specific needs and to match your branding. Check out the sample form below.

COVID-19 Vaccination Registration Form

Streamline how you gather customer, employee, student, or volunteer COVID vaccine information with this COVID-19 Vaccination Registration Form Template from Formsite. Useful to local health departments, pharmacies, pop-up vaccine locations, churches, educational institutions, and businesses, this vaccine registration form is also fully customizable with our drag and drop editor. This sample form template gathers all the data you need, including contact information, whether or not the individual is receiving a second dose or booster shot, whether they have a weakened immune system or pre-existing health conditions, or have had any experience or side effects or severe allergic reactions with past immunizations. Formsite's extensive form builder and style tools let you quickly and easily customize this template so it meets your exact needs. Once it's finished, it can be embedded right into your website, or the link emailed or posted to social media. Patients or employees with vaccine appointments can simply view the form with their mobile device, fill it out, and submit it prior to arrival. For walk-ins to your vaccination clinic, use text messaging to send the link upon arrival. All form data can be sent to other apps, too, including Excel, Word, PDF, Google Suite, and more, so you can send information to the CDC and your local health department.

COVID-19 Pre-Vaccination Checklist

COVID-19 vaccines are in high demand and many healthcare professionals are offering first doses, second doses, and boosters. The Covid-19 Pre-Vaccination Checklist from Formsite simplifies data collection for each vaccine recipient to ensure patient safety and confidentiality regarding the COVID-19 vaccine. Protect yourself, the healthcare providers you work with, and your practice from liability and keep patients safe with this quick and easy to use coronavirus screening checklist. This sample pre vaccination pre-vaccination checklist gathers vital information such as patient name, date of birth, contact information, whether the potential patient has received a first or second vaccine dose, as well as which type of previous dose they received. It also includes form fields that gather information about contraindications including anaphylaxis or any history of severe allergic reaction or side effects to immunizations, as well as current medicines, any immunosuppressive drugs or therapies, whether or not the individual feels sick today, or has a bleeding disorder or takes a blood thinner. There's even a question to cover the possibility of reactions to polyethylene glycol (PEG) or polysorbate. Tailor the form to gather any additional information you need, then embed it on your website, email the link, or post it to social media for easy viewing. No coding necessary! Mobile friendly, this HIPAA compliant screening tool minimizes errors and follows CDC and local health department best practices in gathering and securely storing pertinent patient vaccine information. All form data can be securely downloaded and used in other software applications, too.

Virtual Health Evaluation Form

Quickly and securely gather vital patient information through this easy to use and HIPAA-compliant Virtual Health Evaluation Form Template from Formsite. Healthcare providers in every setting, from face to face primary care settings to virtual care settings, understand the ongoing importance of proper patient data collection, storage, and access. This sample telehealth services patient intake form can help with all of that. Whether due to the COVID-19 pandemic or the lack of rural health access in rural areas, it's increasingly common for virtual healthcare to make up at least some portion of patient care. This virtual health questionnaire gathers pertinent information during the patient intake process like patient name, address, current health insurance, Medicaid, or Medicare information, patient health history, current medications, vaccinations, health concerns, inpatient history, and more. There's even disclaimer language at the end of the form that can be edited to fit your specific health care system or health care services setting. All Formsite forms, including this one, are easy to customize with our drag and drop editor. Once complete, simply embed this form in your website, or email it or share it with new patients on social media with no knowledge of coding necessary. All Formsite form data is encrypted when submitted and while stored, and this form, like all Formsite healthcare forms, is HIPAA-compliant. Try the sample tele patient intake form below.

Handicap Parking Permit Form

Make it simple and straightforward for people with permanent disabilities and temporary disabilities to apply for a handicap parking placard with this Handicap Parking Permit Form Template. This sample disability placard application form makes it easy and fast to gather relevant information like license plate number, drivers license number, date of birth, name and phone number, address or PO Box, qualifying information, and more. HIPAA compliant, this disabled parking permit application form can help you gather and process information more quickly, so you can make sure permanent placards and temporary placards get to those who need them as soon as possible. Our drag and drop editor makes it easy to customize this prebuilt form template. Add a drop-down menu with disability types that qualify for handicap parking privileges like orthopedic conditions, lung disease, cardiac condition, and more. There's no coding or HTML required. Just add and remove fields as you need to in order to create the exact form you want. Formsite forms can be embedded right on your website, so they're easy to find, download, fill out, and submit, and because all our forms are mobile-friendly any disabled person in need of a disability parking placard can access it and submit it from their smartphone or tablet. Forms are also easy to share through email and social media. All eligibility data submitted from completed applications can be fully exported securely and efficiently in a wide variety of other software and apps, including MS Word, Excel, Google Suite, PDF, and more.

Nursing Assessment Form

Improve organizational workflow and streamline nursing processes with the Nursing Assessment Form Template from Formsite. This customizable healthcare template makes it easy to collect details about potential patients' and current patients' physical health and mental status. Use the Nursing Assessment Form Template as-is or add your own fields with our drag-and-drop tool. Caregivers and administrators can set up optional notifications so when a new assessment is submitted to a patient's file, they'll know. Easily share patient data about physical exams and other assessments across changing healthcare teams. More than just a checklist for a physical examination, the Nursing Assessment Form Template is a customizable digital physical assessment that's as thorough and detailed as you want it to be. Easily embed it into your clinic or hospital website for easy access by registered nurses, nursing students, mental health team members, and other professionals involved in a patient's care plan. The prebuilt form covers medical history, blood pressure, vital signs, and other common markers of health and disease. Because the form is fully customizable, you can easily add your own questions depending on your specialties and services. Add questions about hypertension, incontinence, edema, turgor, or lesions — anything you want to ensure your team asks about. Add fields for progress notes and pain assessment. Form data can also be exported in a variety of formats, including MS Word, Excel, and PDF.

Return to Work Form

The Return To Work Form Template from Formsite offers an effortless way for HR departments to manage all employee absences related to a medical condition, sick leave, or a work-related accident. When an employee has a period of absence due to illness or injury, it’s usually necessary for the employee's physician to give them a return to work letter before that employee can return to work. Standardize that process and collect all the information you need with this fully editable work form template. It’s ideal for HR departments looking to streamline their processes, and it can be embedded right into your website. Here’s how it works: Employees can download the release form from the HR department website. Use the Return To Work Form Template as-is to collect details about the employee returning to work, the date of the injury or when the medical condition began, and the name of the healthcare provider involved. You can also add fields to the Return To Work Form Template to customize it for your industry or company. This work release form is also printable and it easily integrates with third-party applications. Submissions can also be automatically saved to your document storage or CRM system for quick access later.