Pharmacy Forms

60 Templates

Whether your pharmacy is administering COVID-19 vaccines, flu shots, or just collecting patient information, do it securely and speedily with Jotform! Whether your pharmacy is part of the CPESN, NCPA, or another organization, you can use this form to collect vaccine registrations, consent forms, surveys, and more from any device. With online Pharmacy Forms, you can quickly customize a template below to perfectly match your pharmacy’s needs — then embed the form in your pharmacy’s website, share it with patients using a link, or have them fill it out in-person on your pharmacy’s tablet or computer.


All templates can be customized to match your company needs and branding. Add your logo, rearrange the layout, choose new fonts and colors, and more with our drag-and-drop Form Builder. Jotform offers HIPAA compliance and a signed Business Associate Agreement (BAA) for Silver, Gold, and Enterprise users, as well as other advanced security measures like GDPR compliance, HIPAA compliance, and more. Create custom Pharmacy Forms that can be filled out on any device with Jotform!

COVID-19 Vaccine Registration Form

Collect COVID-19 vaccine registrations online. Fill out on any device. Easy to customize, share, and embed. Convert submissions to PDFs instantly. HIPAA option.

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COVID-19 Vaccine Consent Form

Collect signed COVID-19 vaccine consent forms online. Easy to customize, share, and fill out on any device. Upgrade for HIPAA compliance. Convert to PDFs instantly.

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COVID-19 Vaccine Survey

Get to know how people feel about the new COVID-19 vaccine with a custom online survey. Easy to personalize, embed, and share. Option for HIPAA compliance.

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COVID-19 Vaccine Declination Form

Document the person's refusal from receiving the COVID-19 vaccination. Copy this COVID-19 Vaccination Declination Form to your Jotform account.

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COVID-19 Vaccine Appointment Form

A COVID-19 vaccine appointment form is used by medical practices to schedule COVID-19 vaccine appointments. It’s been a long time coming, and patients are anxious to get their vaccines administered as quickly as possible — so make the scheduling process as seamless as possible with Jotform’s free online COVID-19 Vaccine Appointment Form. Just customize the form to match your practice, opt for HIPAA compliance to keep patient data secure, embed the form in your website or share it with a link, and start collecting bookings online. Use Jotform’s drag-and-drop Form Builder to quickly add your appointment slots to the calendar widget, which automatically makes bookings unavailable once they have been booked by a previous patient — a great way to avoid double-booking! You can also upload your logo, include extra questions, and further personalize the design — or sync submissions to third-party apps like Google Calendar, Google Sheets, and Slack with our 100+ free form integrations! Improve the way you book appointments for your practice with Jotform’s online COVID-19 Vaccine Appointment Form.

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COVID-19 Vaccine Pre-registration Form

Pre-register your patients for them to receive a COVID-19 vaccine. Copy this COVID-19 Vaccine Pre-registration Form template to your Jotform account.

Healthcare Forms
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COVID Vaccine Consent Form Updated - CPESN

COVID-19 Vaccine Consent Form for CPESN Pharmacies to get online appointments, collect patient data and consent to vaccination terms and conditions.

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Moderna COVID-19 Vaccine Appointment Scheduling and Consent Form - CPESN

This vaccine appointment form is for the use of CPESN facilities to collect online vaccination appointments for the Moderna Vaccine by asking their patients to provide their personal and contact information, current health status and insurance information, vaccine details and consent to each term and condition through e-signature.

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COVID-19 Vaccine Pre-screening Form

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.

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Moderna COVID-19 Vaccine Consent Form - CPESN

This COVID-19 vaccine consent form is for the use of CPESN facilities to collect patient consent regarding the Moderna Vaccine by asking vaccine recipients their personal and contact information, vaccine screening questions, vaccine manufacturer information and vaccine details, with their consent to the detailed terms and conditions regarding the vaccination process.

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Immunization Consent Form - CPESN Pharmacy

This Immunization Consent Form is for the use of CPESN Pharmacies to detect their patients' immunization and payment preference, schedule appointments, collect patient contact information and medical details with their consent to the immunization terms and conditions.

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COVID-19 Vaccine Appointments

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

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Pharmacy Service Satisfaction Survey

Are they satisfied with your service? Want to find out? Make use of our template to help yourself up!

Customer Service Forms
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COVID-19 Vaccine Order Form

Collect COVID-19 vaccine orders online. Fill out on any device. Easy to customize, embed, and share. HIPAA compliance option. Convert responses to PDFs automatically.

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Vaccine Exemption Form

Legally refuse vaccination of your child by using this Vaccine Exemption Form template. This form contains all the necessary data when requesting an exemption from the immunization program.

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COVID-19 Vaccine Registration, Consent and Appointment Form

Collect registrations, consent forms, and schedule appointments in a single online form. Great for pharmacies and hospitals. Easy to customize, share, and embed.

Pharmacy Forms
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COVID-19 Rapid Test Appointment and Authorization Form - CPESN

A CPESN Rapid Test Appointment and Authorization Form is for the use of authorized facilities in WA State to collect rapid COVID-19 test appointments online.

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COVID-19 Testing Consent Form - CPESN Pharmacy

This COVID-19 Testing Consent Form is crafted for CPESN pharmacies in Washington State to get online coronavirus testing appointments by providing their personal and contact information with health details.

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Pharmacy Vaccine Consent Form

A Pharmacy Vaccine Consent Form is used by pharmacies to record a patient's refusal to accept vaccination. Medical practices can also use this Pharmacy Vaccine Consent Form as part of their vaccination tracking process.

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COVID-19 Rapid Test Appointment and Consent Form - CPESN

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.

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COVID-19 Vaccination E-registration Form

The COVID-19 Vaccination E-registration Form is used to register individuals or organizations that would like to receive the free COVID-19 vaccine. The form requests information from the organization or individual requesting the vaccine such as point of contact information, area of residence, type of work or location of work, age and gender.

Pharmacy Forms
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COVID-19 Moderna Vaccination Consent and Release

COVID-19 Moderna Vaccination Consent and Release Form is used to get online Moderna vaccination appointments, collect patient information, and consent with all the necessary contact, health, and insurance details in Hawaii Pharmacies.

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COVID-19 Testing Authorization Form - CPESN Pharmacy

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.

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Disclaimer

These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.