Healthcare and wellness

Vaccination booking

Questions about pregnancy and earlier doses appear only for the people they apply to. Free to use with FillKite.

Live demo

Vaccination booking

Fill it in and press the button to see how it behaves. Nothing you type is saved or sent.

What is in this form

Your name (required)
Date of birth (required)
Vaccine (required)
Sex
Are you pregnant or could you be? (required)
Have you had this vaccine before? (required)
Date of your last dose
Preferred date (required)

How the conditional logic works

This form shows or hides fields as people answer, so everyone sees only what matters to them.

“Are you pregnant or could you be?” appears only when “Sex” is “Female”.
“Date of your last dose” appears only when “Have you had this vaccine before?” is “Yes”.

Use it on your site

Install FillKite free from WordPress.org.
Download this form with the button above.
Go to FillKite → Import → From a FillKite file, choose the file and import it.

Questions

About this form

Is the vaccination booking form free?

Yes. It works with the free FillKite plugin, and you can download it and change it as you like.

Is anything I type saved?

No. This demo runs in test mode: FillKite checks your answers like a real form, but nothing is saved and no email is sent.

How do I use this form on my site?

Install FillKite, download the form with the button on this page, then go to FillKite → Import → From a FillKite file and choose the file. After importing, open it in the builder, change anything you like and add it to a page.

Does this form use conditional logic?

Yes. 2 fields or notices show only when earlier answers call for it. “Are you pregnant or could you be?” appears only when “Sex” is “Female”.

What fields does it have?

It has 8 fields: Your name, Date of birth, Vaccine, Sex, Are you pregnant or could you be?, Have you had this vaccine before?, Date of your last dose, Preferred date.

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