Medical History Form Template

Available on the Free Plan

Your patients can easily fill in this medical history form with their past medications, vaccinations, and major illnesses.

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About this template

Many initial encounters with patients will include asking for the patient’s medical history. Use this medical history form template at your clinic to gather patient medical information faster. The patients can easily fill in the form with their past medications, vaccinations, major illnesses, and surgical procedures. Keep appointments flowing and save time for you and your patients. Our form builder includes numerous options and features that make it easy to both collect patient history information and keep your patients engaged during the process. And if you need additional security, 123FormBuilder is both GDPR and HIPAA-compliant (HIPAA upon request).

Start optimizing your paperwork by switching to 123FormBuilder. You can create a copy of this medical history form with the click of a button and the registration process takes only 60 seconds if you don’t have an account at the moment. So what are you waiting for? Get this medical history form template for free.

Get more than a Medical History Form template

  • Create compliant medical histories with 123FormBuilder.com
  • Save patient data in a secure form builder
  • Keep track of all your patients’ medical history
  • Connect to your online platform and tools
  • Add HIPAA protection to all form entries

Frequently Asked Questions

What is the medical history form?

A medical history form is a document that records all the past illnesses, allergies, accidents, and other patient medical conditions. This information helps healthcare providers decide how to treat a patient. A patient’s medical history is private in most countries, and medical staff cannot disclose it to third parties without following a strict process.

What should a medical history form include?

A personal medical history may include information about allergies, previous injuries, recent illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise.

How do I edit this medical history form?

Customize this medical history form template on 123FormBuilder with simple drag & drop. No coding is needed. Select from a variety of form fields to use and enable data encryption that will keep the data confidential and safe. Upon request, we provide a special package for HIPAA compliance.

How can I share this form template?

Publish the medical history form on your website or share it with your patients directly on email. It’s up to you and it’s easy as 1-2-3. All you have to do is copy & paste the final code of the medical history form once you are done editing it.

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