Event Sign-Up Template

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This is a sample form for any students utilizing the Cancer Screening Event Toolkit. It allows clients to sign up for a time slot on the day of your screening event. Each appointment is 20 minutes, and up to 3 individuals can sign up for each slot, assuming that your venue will have multiple examination rooms. Please do not edit this original template, and make a copy saved to your Google Drive to edit as you wish. There is an add-on called "Choice Eliminator" that allows you to set a response limit for your time slots if you desire more or less than 3.

Link to directions: https://www.wikihow.com/Make-a-Time-Slot-Sign-Up-Sheet-on-Google-Forms

Don't forget to change the title and description of your form before it goes live! If you have any questions, please email cancer@apamsa.org.

Email *

First Name *

Last Name *

Birth Date (MM/DD/YYYY) *

YYYY

Select one timeslot below *

Would you like your screening results sent to your primary care physician? *

Yes

Maybe

We need your physician's information to send them your screening results. Please provide your physician's full name:

Physician's phone number:

A copy of your responses will be emailed to the address you provided.

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