Medical History Questionnaire Template

Customize this medical history questionnaire template in any way you need and share it online. No coding needed, just 123FormBuilder.

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About this template

Are you a medical professional? If you want an easy and secure way to collect information about a patient’s medical history, this form is exactly what you need. All you have to do is get this medical history questionnaire template, customize it as you see fit using our survey maker (or based on the specific legal requirements in your country/state), and then publish it to make it easily accessible to patients. We can also provide HIPAA compliance for your survey should you need it on 123FormBuilder. Request a quote to learn more.

Frequently Asked Questions

What is a medical history questionnaire?

A medical history questionnaire allows a medical doctor to know as much as possible about a patient’s medical history, so they know which type of treatment to follow.

What questions do you ask for medical history?

In general, a medical history questionnaire should allow you to know as much as possible about your patient’s medical history. Ask about them, their contact details, heart, liver, or kidney diseases, thyroid dysfunctions, and other common illnesses. Other information such as their history of surgeries, a genetic history of a disease in their family, and whether they are medicated or suffering from any kind of allergies can be included too.

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