Deooch Forms
TemplatesIntegrationsMCP connectorsDocsBlogPricingContactLog inStart free
Form templates›Healthcare

Vaccination Record Form

Collect proof of vaccination once, with the dates, the batch, and the certificate attached, so you never have to ask twice.

Vaccination Record Form

Collect proof of vaccination once, with the dates, the batch, and the certificate attached, so you never have to ask twice.

Vaccination detail

Proof

A photo or a PDF, as long as the dates are readable.

Powered by deoochform

Use this template

Opens in the builder. Nothing is saved until you edit it.

Fields
12 questions
Theme
Ocean, switchable in the preview
Updated
11 August 2026

Categories

  • Healthcare
  • Healthcare Forms
  • Compliance Forms
  • Upload Forms

Ideal for

  • Clinics
  • HR teams
  • Schools
  • Care providers

Best used in

  • Staff compliance
  • School enrolment
  • Travel requirements

About this template

Collecting proof of vaccination by email produces a folder of attachments with no structure, and no way to answer a question like which staff are due a booster. This form captures the vaccine, the dates, and the batch as separate fields alongside the certificate, so the record is queryable rather than just stored.

Two dose date fields rather than one is the small decision that makes this useful later. Schedules differ per vaccine, and keeping the doses apart means you can calculate who is due without opening a single certificate. The batch number is there because it is the first thing asked for if a batch is ever recalled.

The reactions field is worth keeping even though most people leave it blank, since it is the only place an adverse event gets written down. Make the second dose required if the vaccine you are tracking always needs two, and set a retention period before you launch it.

Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.

Fields in this template

  • Full name*Short text
  • Date of birth*Date
  • Email address*Email
  • Which vaccination is this?*Dropdown
  • If other, which one?Short text
  • Date of first dose*Date
  • Date of second dose, if you had oneDate
  • Batch or lot numberShort text
  • Who administered it?Short text
  • Vaccination certificate*File upload
  • Did you have any reaction we should record?Long text
  • Consent*Multiple choice

Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.

Related templates

Browse all templates

  • Appointment Request Form

    Appointment details

    Preferred date
    Preferred time
    Reason for the appointment

    Contact information

    Full name
    Email address
    Phone number
    Is this your first visit?
    YesNo
    Appointment Request Form

    Let clients book time with you. Collect their details, the reason for the visit, and a preferred date in one pass.

  • Patient Intake Form

    Patient details

    Full name
    Date of birth
    Email address
    Phone number
    Home address

    Medical history

    Reason for today's visit
    Have you been diagnosed with any of the following?
    High blood pressureDiabetesAsthma or respiratory condition
    Current medication and dosage
    Patient Intake Form

    Gather medical history, medication, and insurance details before a first appointment instead of on the clipboard in reception.

  • Medical History Form

    Full name
    Date of birth
    Contact number
    Email address
    Home address

    Current health

    Have you ever been diagnosed with any of the following?
    High blood pressureDiabetesAsthma
    Please give dates and treatment for anything you ticked
    Medication you take regularly
    Allergies
    Medical History Form

    Take a full history before the first appointment, so clinical time goes on the consultation rather than on filling in a paper form.

Deooch Forms

Describe a form in plain English and it builds itself. Collect responses in one place and export to Excel.

Product

TemplatesIntegrationsMCP connectorsPricing

Resources

DocsBlogAboutContact

Account

Log inSign up
© 2026 Deooch Forms
PrivacyTerms