Immunize RX Consent form

Form Template

Doctors, Nurses and healthcare professionals will find this mobile app very handy in acquiring immunization consent from the patient or guardian.

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The app is designed to display only relative information based on the type of vaccination (Pneumonia, Tdap, Flu) selected. This helps speed up the process, and professionals can capture a photograph of the insurance card right from the app and submit at real time. When you complete this app, GoCanvas will automatically store your information in your account in a secure location in the GoCanvas Cloud, or email a PDF. You can access your data anytime from the GoCanvas Cloud.

Features
  • Signature Capture
  • Image Capture
  • Submission Editing
  • Reference Data
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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