A coronavirus self-assessment form is filled in by patients to inform a hospital or doctor’s office of any coronavirus symptoms they may have. By collecting patient contact details, emergency contact details, symptoms, and coronavirus exposure information with an online Coronavirus Self-Assessment Form, you can take an important step in diagnosing patients with COVID-19. To get started, just customize the form, send it to your patients, and instantly receive their submissions in your secure Jotform account.
This Coronavirus Self-Assessment Form already comes equipped with important health questions, but feel free to add more with our drag-and-drop Form Builder. It only takes a couple of minutes to make your form look and function like you need it to. And if you need to automatically relay responses to your other accounts, use our 100+ free integrations. By allowing your patients to fill out this free online Coronavirus Self-Assessment Form remotely on any device, you can more easily diagnose and treat coronavirus patients while keeping your staff protected.