Quick Vaccination Record — shared by the community
Tom H. shared this 14-question build with 3 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 14 questions, 1 page, 3 conditional rules.
- Shared by
- Tom H. · Agency owner
- Questions
- 14
- Replies
- 20
- Copies taken
- 717
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Live preview and test console
This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.
1 question is hidden by conditional logic right now — change an answer above to reveal it.
Works for you? Take Tom H.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Quick Vaccination Record is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 14 questions across 1 screen.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 11 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It pins the request to a specific date.
- Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Quick Vaccination Record lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 3 conditional rules ship with it.
- Features conditional validation: if “Anything observed after the dose?” is Yes, “What was observed?” becomes mandatory before the form can be sent.
- Features advanced show logic: if “Which dose is this?” is First dose, the form dynamically exposes “Next dose due”. Otherwise that question never appears.
- Features conditional validation: if “Was consent recorded before the dose?” is No, “Note for the clinical lead” becomes mandatory before the form can be sent.
- All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Dose given
- Patient full namerequired
- Date of birthrequired
- Vaccine product givenrequired
- Batch numberrequired
- Batch expiry daterequired
- Which dose is this?required
- Site usedrequired
- Date givenrequired
- Next dose due
- Administered byrequired
- Was consent recorded before the dose?required
- Anything observed after the dose?required
- What was observed?
- Note for the clinical lead
Conditional logic in this build
- When “Anything observed after the dose?” is Yes, require “What was observed?”.
- When “Which dose is this?” is First dose, show “Next dose due”.
- When “Was consent recorded before the dose?” is No, require “Note for the clinical lead”.
Questions about this shared form
Does this replace consent?
No. Consent is taken before the dose using the Immunization Consent Form, and this record simply notes whether that happened so a gap is visible immediately rather than at audit.
Can pharmacies use it?
Yes. The fields match how a pharmacy session runs, and the administered-by question keeps the record clear when several people vaccinate from one station.
Why ask for site and side?
Because a later query about a reaction needs to know where the dose was given, and it is a two-tap answer at the time and unanswerable a week later.
How long should these records be kept?
Follow the retention rules that apply to your setting and country rather than a default; set the schedule before the first clinic so nothing is deleted early or kept indefinitely.
Is the Quick Vaccination Record template free to use?
Yes. You can preview and test Quick Vaccination Record on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Quick Vaccination Record template ask for?
It asks 14 questions across 1 page, 11 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Quick Vaccination Record form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
3 conditional rules ship with the template: Features conditional validation: if “Anything observed after the dose?” is Yes, “What was observed?” becomes mandatory before the form can be sent. Features advanced show logic: if “Which dose is this?” is First dose, the form dynamically exposes “Next dose due”. Otherwise that question never appears. Features conditional validation: if “Was consent recorded before the dose?” is No, “Note for the clinical lead” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.
Where do responses to the Quick Vaccination Record form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Quick Vaccination Record form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
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