Emergency Contact Form Template

Do you want to collect emergency contact information and keep it in one convenient location? If so, you need an emergency contact form. With WPForms’ emergency contact form, you can gather emergency contact information and access it on the backend of your website with just a few clicks.

With WPForms’ emergency contact form, collect information about the person you’re in charge of or working with, including their birthday, primary care physician, and contact information. In addition, gather the emergency contact’s name, address, phone numbers, and relationship to the person in your charge.

We have created an emergency contact form demo below that you can use to easily get started without any technical knowledge.

What’s in the Emergency Contact Form Demo

Launch this form as-is or customize it to your heart’s content!

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Emergency Contact

With our Emergency Contact Form Template you get the following form fields:

  • Name
  • Address
  • Date / Time
  • Email
  • Phone
  • Single Line Text
  • Section Divider

Of course, this is just an emergency contact form sample to get you started.

You can use our easy to use drag & drop form builder to add, remove, and customize the fields as needed.

For instance, you can enable smart conditional logic to display an additional form field once someone enters a primary care physician name. This way you can collect the phone number and address of the physician in case you need to get in contact with them right away. You can also add a form field so those in your charge can include any pressing medical issues or allergies they have. Knowing this information in the case of an emergency is helpful for medical personnel when something happens and a person is incapacitated.

If you want to really make sure you’re prepared in the case of an emergency, add form fields to your emergency contact form template so the person in your charge can enter their driver’s license number, social security number, and insurance information. Again, if incapacitated, someone experiencing a medical emergency will not be able to relay this information to the right people. Being prepared can save a life and make a huge difference in the outcome of an emergency.

If you want to make sure that the emergency contact on file is authorized and willing to be the point of contact for the person in your charge, add a Checkboxes form field to your emergency contact form so they can agree to being the emergency contact.

In addition, add a Signature form field to your emergency contact form template so the emergency contact can sign and take responsibility for the person under your care in the case of an emergency. This is an added liability you don’t want on your hands, so getting electronic signatures can safeguard you from legal trouble should a significant emergency occur.

So, what are you waiting for? Get started with WPForms today to create your own emergency contact form. Bonus, we’ll give you our emergency contact form template and over 100+ other pre-made form templates!

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