COVID-19 Health Screening Web
With Modern Metro Theme

"Health Screening Web Form"

Elevate Engagement with Wizara’s Easy-to-Use Forms!
COVID-19 Health Screening Web Form Template

COVID-19 Health Screening Web is the essential tool for safeguarding public health. This comprehensive form collects crucial health information, ensuring a safe environment for all. Seamlessly integrated into your website, it's user-friendly and secure, demonstrating your commitment to health compliance.

Pairing the COVID-19 Health Screening Web with the Modern Metro theme elevates your form's aesthetic appeal. The minimalist design, borderless inputs, and soothing color palette create a modern, engaging experience for users. Enhance your form's functionality and visual appeal with Modern Metro, setting a new standard for health assessment forms.

COVID-19 Health Screening Web Features

Streamline Health Assessments
Streamline Health Assessments
Efficiently collect vital health information to prevent the spread of COVID-19 and ensure a safe environment for all.
Enhance Compliance Strategies
Enhance Compliance Strategies
Demonstrate due diligence in safeguarding health with interactive, secure, and customizable forms for various industries.
Modern Metro Design
Modern Metro Design
Create a sleek, user-friendly experience with a minimalist aesthetic and versatile light/dark mode adaptability.
Borderless Inputs
Borderless Inputs
Promote uninterrupted visual flow and engagement with seamless, rounded corners and full-width form design.
Large Submit Button
Large Submit Button
Boost user interaction and visibility with a prominent, easy-to-click submit button for a seamless form experience.
Secure Data Collection
Secure Data Collection
Protect personal health information with a secure, HIPAA-compliant form that integrates seamlessly into your website.
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 "Modern Metro" form theme. You can change the colors and the theme using the Wizara Form Builder app.