Use the medical history form template to provide essential medical details to healthcare providers. The health facility needs accurate and detailed historical medical information to treat people safely.
Check out the medical history form below:
Form PreviewUse This Template
What Should Be on a Medical History Form?
The form should include:
- Patient contact details
- Patient’s healthcare professional’s information
- An extensive questionnaire about the patient’s medical background
- The patient’s signature acknowledging the terms and use of providing this information
What’s in Our Medical History Form?
In our medical history form template, we’ve asked if patients have any current medical conditions, if they’re currently taking medication, to list any allergies, congenital disorders, and anything that hasn’t been mentioned.
With this template, you can quickly and easily edit it. Take your medical history questionnaire to the next level and ask the patient their weight, alcohol and tobacco consumption, and if they have any hearing, sight, or mobility issues.
You can then add a ‘Have you ever had’ section. This is where you can retrieve comprehensive detail. Ask if they have or had asthma, angina, bone or joint disease, liver disease, addiction, and more!