Vaccination Refusal Form Template

Even being aware of the intensity of a disease, there are certain individuals who refuse to take vaccination for reasons best known to them. But, being a health care agency, it is your responsibility to remind them of the adverse effects and take their acknowledgment of refusal. This Vaccination Refusal Form Template is designed keeping all your requirements in mind and more!

Multilingual Survey

There might be a mix of people from different origins who’d not want to take the vaccine. Make it easy for them to understand the scenario. This refusal to vaccinate form template supports over 50 languages. Thus, your respondent can answer in any language they’re comfortable in.

Accept Signatures

A form with such an intense intent, needs to be signed to avoid any further confusion. Thus this template provides you with a signature question type to accept signatures from your respondents. This question type allows your respondents to upload, draw or type their signature.

Terms & Condition Question Type

When refusing a vaccine, one must understand and accept all the terms and conditions related to the ailment. So add the terms & conditions question type to clearly mention all the adverse effects of not taking the vaccine and let your respondents give consent to the same.

Device-Friendly Form

This form template lets your respondent answer the question at ease. Therefore we’ve designed it to be compatible with multiple devices like a phone, a tablet. A laptop or even a desktop. This prevents your respondents from avoiding the form and eliminates the delay of choosing a device and then responding.

Personalized Form

When you’re trying to make your respondents understand a certain thing, it is very important to connect with them. And what’s better than a personalized form? Use variables, expressions and customizable parameters in your form to make it a tailor made one!