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COVID-19 Health Screening Web
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With Noir Elegance Theme
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"Health Screening Web Form"

Elevate Engagement: Add This Form to Your Website!
COVID-19 Health Screening Web Form Template

COVID-19 Health Screening Web is your essential tool for safeguarding health in these challenging times. This comprehensive form ensures a thorough health assessment, helping prevent the spread of COVID-19 by gathering crucial information efficiently. Seamlessly integrate this form to your website and showcase your commitment to public health and safety.

Enhance the visual appeal of your COVID-19 Health Screening Web form with the Noir Elegance theme. Its modern sophistication, featuring a dark violet backdrop and sleek design elements, adds a touch of elegance to your health assessment process. Stand out with the bold purple submit button and geometric Montserrat font, creating a captivating user experience. Take a proactive step towards a healthier environment by leveraging the power of Wizara forms today!

Get Started Using This Form Template

COVID-19 Health Screening Web Features

Streamline Health Assessments
Streamline Health Assessments
Efficiently collect vital health information with our COVID-19 Screening Form, ensuring a safe environment for all.
Ensure Compliance & Safety
Ensure Compliance & Safety
Demonstrate due diligence in health and safety compliance, safeguarding employees, customers, and the community.
Modern Sophistication
Modern Sophistication
Elevate your online presence with "Noir Elegance," a sleek and stylish dark violet form theme for a sophisticated look.
Stand Out Submit Button
Stand Out Submit Button
Make a bold statement with a standout purple submit button that grabs attention and encourages user engagement.
User-Friendly Design
User-Friendly Design
Seamlessly integrate our forms on your website with a user-friendly, secure, and accessible design for all users.
Real-Time Updates
Real-Time Updates
Stay informed with interactive features that allow for real-time updates based on evolving guidelines and situations.
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)
title
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 "Noir Elegance" form theme. You can change the colors and the theme using the Wizara Form Builder app.