Contact tracing form template

Contact TracingThank you for helping us to prevent the spread of coronavirus COVID-19.What's your full name?Thanks, {{field:01F5JV3VAK5G3X3354NT5PQ97X}}. And what's your phone number?And your date of birth?What's your address?And your email address?Please select the option that applies to you

I have tested positive for coronavirus, I am experiencing symptoms of coronavirus

Have you been in contact with anyone since testing positive?Have you been in contact with anyone since your symtpoms began?Please give the details of the people you have been in contact with - name, phone number and address.Thank you for filling in our contact tracing form

Collect up to 3.5x more data with Typeform

Continue the fight against coronavirus COVID-19

A readymade contact tracing form to help you prevent the spread of COVID-19 in your local community

With Typeform, you can customize everything

Change text, colors, and even logos to match the look and feel of your brand. Then embed forms smoothly onto web and email.

Make forms feel effortless to fill out. Pace questions, call people by their name, and adapt the flow based on the data they share.

Stay efficient by connecting forms to your workflow. Typeform integrates with 300+ tools including Slack, Zapier, and HubSpot.

Contact tracing form FAQs:

To protect public health, some basic details must always be included in a contact tracing form. The person’s contact details and those of anyone they have been in contact with are top. Then it’s up to you if you would like to request any other relevant information for your situation. Typeforms are customizable so you can include other questions, such as asking about specific COVID-19 symptoms, whether they are in quarantine, etc.

Before you send out your form, there are two things you should do:

Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. To do this you would need to talk to us about our enterprise plan, which you can do by filling out this Typeform, or contacting your Typeform account manager.

Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.