COVID-19 Health Screening Web
With Base Theme

"Health Screening Web Form"

User Experience Redefined: Click & Add Our Form!
COVID-19 Health Screening Web Form Template

Keeping our communities safe is more important than ever in these challenging times. That's why our COVID-19 Screening Form is an indispensable tool for any organization or business. This form is designed to provide a thorough health assessment, helping to prevent the spread of COVID-19 by ensuring that individuals who may be at risk of infection do not enter your premises without proper checks.

This web form allows users to confirm their health status by checking for common COVID-19 symptoms, any recent contact with infected individuals, and travel history that may influence their risk level. With its straightforward design, the form can be quickly filled out, ensuring that the necessary health information is collected efficiently.

Integration of this form into your website is seamless. It's designed to be user-friendly, making it accessible to everyone, regardless of their technical skill level. Additionally, the form is secure, ensuring that all personal health information collected is protected.

For businesses and organizations, this form is a critical part of your health and safety compliance strategy. It demonstrates due diligence in safeguarding the health of your employees, customers, and the wider community. Moreover, it's interactive, allowing for real-time updates based on the evolving situation and guidelines.

This form is a must-have for:

  • Healthcare facilities looking to pre-screen patients before appointments.
  • Educational institutions aiming to monitor the health status of students and staff.
  • Corporate offices implementing health checks as part of their return-to-work policies.

Event organizers requiring health clearance for attendees.

By utilizing our COVID-19 Screening Form, you're not only streamlining your health assessment process but also showcasing your commitment to public health and safety. Add this essential tool to your website today and take a proactive step towards a healthier environment for all.

COVID-19 Health Screening Web Features

Streamlined Health Assessment
Streamlined Health Assessment
Efficiently collect crucial health data with a user-friendly design for quick and accurate screening.
Secure Data Collection
Secure Data Collection
Protect sensitive health information with our secure form, ensuring HIPAA compliance and data privacy.
Real-time Health Updates
Real-time Health Updates
Stay informed with interactive features that adapt to evolving guidelines and health situations.
Versatile Healthcare Integration
Versatile Healthcare Integration
Seamlessly integrate into healthcare systems for streamlined patient intake and accurate data integration.
Proactive Health Compliance
Proactive Health Compliance
Demonstrate due diligence in health and safety compliance, showcasing commitment to public health.
Essential Health Screening Tool
Essential Health Screening Tool
Prevent the spread of COVID-19 with a thorough health assessment form for businesses and organizations.
COVID-19 Health Screening Web Form Template
Customizable Form Fields
You can add, remove or re-arrange form fields when using our form builder app.
title (html-block)
fullName* (text, input)
Full Name
email* (email)
Email Address
phoneNumber* (phone-number)
Phone Number
symptoms* (boolean, buttons)
Have you experienced any COVID-19 symptoms in the last 14 days?
contact* (boolean, buttons)
Have you been in close contact with a confirmed or probable COVID-19 case?
travel* (boolean, buttons)
Have you traveled internationally in the last 14 days?
additionalInfo (text, textarea)
Additional Information

Try Out the Form for Yourself!

Experience Ease and Flexibility Across Multiple Devices and Screens

The form below is using our "Base" form theme. You can change the colors and the theme using the Wizara Form Builder app.