Vaccination Interest
Healthcare
Gauge interest in a clinic date with which vaccines they are asking about and a preferred window — not a standing order.
A vaccine clinic that only posts a flyer cannot count vials. This GRTforms template asks which shots people are interested in and a preferred week. It is interest intake so you can staff a date — not an order, not a consent, and not medical advice.
Who it is for
Public-health desks, school clinics, and primary-care offices that run seasonal shot days.
When to use it
Use it to size a clinic. Appointment Request is a reserved slot. Wellness Screening is a broader check. Event Registration is a public event that happens to include a table. New Patient Intake is a first chart.
What this form collects
Name, email, optional phone, vaccine interest checkboxes, who it is for, optional week, existing-patient radio, optional questions, and a hidden campaign field you can prefill.
- Fall flu-clinic headcount
- School-required catch-up day
- Employer on-site clinic RSVP that is not a ticket
Preview mode: This is a live read-only render of the template. Sign up to clone it into your account, or customize it with the guest AI builder first.
Vaccination Interest
Frequently asked questions
Does this book a shot?
No. It is interest. You still publish a date or convert people to Appointment Request. Do not treat a submission as consent to vaccinate.
Can I collect insurance here?
Add plan fields after you clone it if your clinic bills. Keep payment off this template. Eligibility is still a staff check, not advice from the form.
What is the hidden campaign field for?
Prefill `?utm_campaign=flu-2026` from posters or texts so you can see which flyer worked. Hidden fields store with the submission and stay off the page.
Related templates
Nearby GRTforms templates for the same job or the next step after this one.
Wellness Screening Signup
Sign people up for a scheduled screening event with which checks they want and a group affiliation — not a clinical result.
Appointment / Booking Request
Request an appointment with a preferred date and time window.
Event Registration
Professional event registration with attendee details, session (in-person/online), and dietary needs.
New Patient Intake
Open a first-visit file with identity, a reason for coming, and optional coverage details — intake only, not a chart.
Appointment Cancellation
Let a patient release a slot with the visit date, who they were seeing, and whether they want a new time.