Templates Education Health Physical Form Template

Health Physical Form Template

Use This Template
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Patient Information

Patient's Name

Physical Information

Click or drag a file to this area to upload.

Administrator Information

Medical Professional's Name
Clear Signature

In the pursuit of comprehensive health management, our Health Physical Form Template empowers you to gather essential patient information efficiently.

This versatile form covers a range of health metrics and ensures seamless communication with medical professionals. Find out how to use this form template on your site.

How to Use the Health Physical Form Template

This form is great for physicians, nurses, or any other medical professionals that administer health physicals to patients.

Our form template is completely customizable, or it’s ready for use right away. It comes preloaded with all of the necessary sections and fields to get you started.

Under the Patient Information section, we’ve included the following fields and functions:

  • Patient’s Name: Require the patient’s full name for accurate record-keeping.
  • Birthdate: Record the patient’s date of birth to have their age on file.
  • Gender: Allow options for the patient’s gender for personalized care.

Then, in the Physical Information portion of the form, you’ll find these fields and details:

  • Height & Weight: Document the patient’s height and weight for a comprehensive approach.
  • Heart Rate & Blood Pressure: Monitor the patient’s heart rate and record their blood pressure for accurate health tracking.
  • Vision & Hearing Test Results: Include results from vision and hearing tests to centralize the patient’s health information.
  • Physical Exam Notes: Allow space for observations from the physical examination.
  • Vaccine History: Keep a record of the patient’s vaccination history for easy reference across many uses.
  • Allergies: Document any known allergies to ensure future safety.
  • Medications: Collect a list of current medications for a fully detailed health scope.
  • Additional Documents: Allow file uploads for supporting documents.

Finally, in the Administrator Information section, the medical professional enters information for these fields:

  • Medical Professional’s Name: Collect the attending medical professional’s name.
  • Email: Require an email address for easy communication.
  • Phone: Get a contact number for quick access.
  • Signature: Collect a digital signature for authentication by the medical professional.

By using the Health Physical Form on your website, perhaps internally for your staff and colleagues, you’re unifying the data collection process across your group of healthcare professionals.

Sign up with WPForms to create your own Health Physical Form. Signing up gives you access to this form template along with an extensive library of others.