Customize the Vaccine Eligibility Form

Edit the text, fields, privacy and legal attestations, images, and redirect button in the vaccine eligibility form.

The Vaccine Eligibility Form package includes four Visualforce pages for you to customize with your own text and images.

You can edit all this information in the Visualforce pages.

Text and Fields

Edit the text for each Visualforce page that we create in your org: Vaccination Sign-Up Form, Vaccination Sign-Up Success Page, Vaccination Sign-Up Start Page, and Vaccination Sign-Up Error Page.

In Vaccination Sign-Up Form, modify the form fields to change the information that you collect from recipients.

Note Be mindful of the values you store about your recipients. We recommend that you avoid collecting information that you don’t need and any sensitive information that could be used for discrimination or other unlawful uses. For more information, see our Acceptable Use and External-Facing Services Policy.

To edit the picklist values on the Occupation and Area of Interest fields, include the new value as a custom label and refer to it in the Visualforce page. These are the values in the form by default:

• Occupation
  • Chemical & Hazardous Materials
  • Communications & IT
  • Critical Manufacturing
  • Defense
  • Education & Child Care
  • Emergency Services
  • Energy
  • Financial Services
  • Food & Agriculture
  • Government/Community Based Essential Functions
  • Healthcare Worker
  • Industrial, commercial, residential sheltering facilities and services
  • Retired
  • Transportation & Logistics
  • Unemployed
  • Water & Wastewater
  • Other
• Area of Interest
  • Covid-19 Care
  • New Patient Inquiry
  • Find a Doctor
  • Refer a Patient
  • Other

Privacy and Legal Requirement Attestations

The checkboxes in the sign-up form contain attestations that fulfill legal requirements around obtaining consent for collecting recipients’ information, receiving consent to contact them, and having recipients acknowledge they have received relevant information about the COVID vaccines and their risks and benefits.

Important The provided text is intended as a sample only and should not be used in place of your own legal requirement attestation text for these checkboxes. Please consult with your organization’s own legal counsel to include appropriate language for your own particular use cases and to ensure compliance with local privacy and healthcare laws, as well as any other applicable laws or guidance.

You must:

• Edit Vaccination Sign-Up Form to replace the checkbox text with your own policies and legal requirements.
• Replace the placeholder text with your organization’s own legal requirements attestation language, as provided by your organization’s legal counsel. This can include a brief privacy statement and acknowledgement with a link to your company’s main privacy notice or statement.
• Confirm that you’re complying with all applicable laws and regulations before sending your sign-up form to recipients.

Images

To use your own images in the sign-up flow, upload them as static resources and save the static resource names. Then, edit each Visualforce page in the vaccination eligibility sign-up flow and replace the image references from the placeholder images to your images.

We recommend that any people in your images are shown wearing protective face masks.

Redirect Button

The confirmation step in the sign-up flow contains two placeholder buttons: View FAQs and New Sign-Up. The View FAQs button contains a redirect link.

Edit the Vaccination Sign-Up Success Page and replace the View FAQs button text and link to reflect the page or resource where you want to redirect recipients after they’ve completed the form.

Important If the Default Web Address is populated in the Force.com site for the four Visualforce pages, update the page references. For example, your page reference might change from .../apex/vaxpk__PreRegEntry to .../YOURWEBADDRESS/apex/vaxpk__PreRegEntry.