Coronavirus Screening Form
A coronavirus screening form is used by healthcare organizations to see what coronavirus symptoms their patients are showing, either to diagnose them with COVID-19 or for contact tracing purposes. Whether you work for an in-person doctor’s office or are collecting information remotely for telemedicine, use this free Coronavirus Screening Form to better understand the symptoms of your patients. Just customize the form to match your practice, then embed it in your website or share it with patients directly to have them fill it out on their computer, tablet, or smartphone. Responses are stored securely in your Jotform account, supported with HIPAA-friendly features if you upgrade.
This Coronavirus Screening Form template already has fields for contact information, symptoms, and contact tracing purposes — but if you’d like to add extra questions or make the design match your practice by adding your logo or changing colors, do it in a couple of clicks with our drag-and-drop Form Builder. Instantly send submissions to your other accounts too — like Google Drive, Dropbox, Box, and more — with our 100+ free form integrations. By tracking the symptoms of your patients with a custom Coronavirus Screening Form, you can take steps to diagnose patients with COVID-19 and prevent it from spreading.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
These templates are suggested forms only. Before using this or any form as a contract or other legal document, please consult with an attorney to make sure it meets the legal needs or your situation. Do not use this form to send a legal request to Jotform.
