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
  • 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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