Healthcare Forms

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Sunshine Pharmacy

A COVID-19 Rapid Test Appointment and Consent Form is used by medical practices to set up appointments for the COVID-19 Rapid Test and to collect consents from patients.

Pre registration

Use for pre screening of Phase 1c COVID vaccine

A COVID-19 Phase 1C Vaccination Registration Form is used to register a COVID-19 vaccine for adults aged 40 to 64 with high risk medical conditions and essential workers, who are not covered in other phases.

A COVID-19 Phase 1B Vaccination Registration Form is used to register a Law Enforcement or Fire personnel for the COVID-19 vaccine. This template collects contact information and details for Law Enforcement or Fire workers so that they can receive the vaccinations at no charge.

Rapid COVID-19 Testing Purchase Form is a form template that simplifies the process of obtaining essential COVID-19 tests, provided by Jotform to enhance the user experience and facilitate ease of access.

Pharmacy screening form for 1a covid vaccine

Collect COVID-19 Phase 1A vaccine registrations online. Easy to customize, share, and embed. Turn into PDFs instantly. Protect data with HIPAA friendly features.

Used to identify the people who will receive the COVID-19 vaccination based on Kansas Department of Health and Environment's requirement.

For use by authorized individuals only

GuidePoint Pharmacy COVID-19 questionnaire

The COVID-19 Vaccine Pre-screening Form is used by medical practitioners and pharmacists to screen potential COVID-19 vaccine recipients to determine whether there is any reason the patient should not receive the COVID-19 vaccine. Once screened, the individuals may be sent for further evaluation if they do not meet the necessary conditions.

NYS Contact tracing form

Intended for use only by Hometown Drug Inc. (Ennis, Texas) employees

This COVID-19 Rapid Test Appointment and Consent Form, updated on 12.16.2020, is for the use of CPESN facilities, specific to WA State, to gather coronavirus test appointments online.

This COVID-19 Testing Authorization form is for CPESN Pharmacies to schedule testing appointments online and collect their patients consent to the coronavirus testing terms and conditions. Form simply asks patients to provide their personal and contact information, and their e-signature.

COVID-19 Screening and Consent form for NY Pharmacies with LSL.

Used for individuals in Phase 1-A groups to book COVID-19 vaccine appointments. Allows for multiple people per time slot.

Staff and Student COVID-19 Self Screening Questionnaire

Perform checks on patients intubated due to the coronavirus. Fill out a secure online form on any device. Easy to customize. Protect data with HIPAA compliance.

A COVID daily health screening form is used by medical practitioners to monitor a patient’s health and lifestyle. Use a free daily health screening form to collect medical information from your patients online.

Ontario Ministry of Health Screening Questions