Medical History Form Template

Easily send and receive your medical history form online. Send patients your medical history form to fill out on their phone, tablet, or computer. Patients securely sign and submit completed forms directly to your account. Track your patient's progress, send automated reminders, and receive completed medical history forms online.
Medical History Form Template

Medical History Form Template

Give your patients the freedom to complete medical history forms with any device, anywhere. Streamline the way you collect signatures and health history forms by setting up your form online. 

Easily personalize this medical history form template with a HIPAA compliant form builder.

Setup a medical history form for free

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What is the Medical History Form?

A medical history form is used to disclose a patient’s past medical details to healthcare providers, physicians, and dentists.

The purpose of the medical history form is to show the physician important information regarding the patient’s health. The information entered on this form will determine care requirements and the risk factors for that patient. Medical history forms can vary depending on the physician’s treatments, and therapists have forms with extensive questioning on psychiatric health issues.

It is also important to include medical history milestones including; surgeries, tests or treatments, that the patient may have received. Collect accurate dates of these events and any details that the patient is able to provide with the medical history form.

The history form can easily be the largest form that is given to the patient. These forms are best sent to patients before the appointment, so they may have more time to fill out and not feel pressured to complete during their visit. Send medical health history forms online and give your patients the freedom to complete your form with any device, anywhere.

More Online Medical Forms

Streamline your medical forms online. Automate your paperwork. Start saving time and money.

Advance Beneficiary Notice of Noncoverage

Easily keep your patients informed, while fulfilling Medicare requirements by sending this form when you suspect an item may not be covered under Medicare. Keeping your patients informed empowers them with the information to make the best health and financial decisions.
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HIPAA Authorization Form

Stay in compliance and make sure you have the correct HIPAA information on file for each patient. The electronic HIPAA Authorization form is customizable and an easy way for your patients to keep their information updated.
Medical Consent Form Template

Medical Consent Form

Easily have patients complete your medical consent form with their phone, tablet, or computer. Make it easy for patients to complete your consent forms online.

Notice of Privacy Practices

Easily comply with the HIPAA Privacy Rule by providing your patients with an electronic privacy notice to read and complete before the initial visit. The notice can be read when convenient, signed and then returned for an informed, efficient clinic visit.
hipaa-consent-form-template

HIPAA Consent Form

Give your patients the freedom to complete HIPAA consent forms with any device, anywhere. Streamline the way you collect signatures and consent forms by setting up your form online.
Patient Intake Form Template

Patient Intake Form

Easily have patients complete your patient intake forms online. Completed patient intake forms are submitted securely to your account, before the patient's appointment.
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Insurance Form

Use the Insurance Form to gather all of the necessary pieces if information to contact, obtain pre-authorization, and bill patient insurance plans. Customization and required fields makes records complete the first time.
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PHQ-9 Modified for Teens

Give your teen patients the freedom to complete the PHQ-9 from any device, anywhere. Ensure privacy and help keep teens safe by ensuring completion of this screening form before their clinic visit.

Setup a medical history form for free

Start saving time and money with FormDr

Discover More Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Reporting

Custom Reporting

Monitor text messaging effectiveness to see patient response rates, track appointment scheduling trends to reduce no-shows, and analyze phone call data for improved communication. Gain insights into your opportunity pipeline to identify potential patients and increase conversions, while leveraging mass messaging analytics to measure outreach success.

Trusted Devices Authorization

Skip two-factor authentication using Trusted Devices. Trusted Devices provides an extra layer of security for your FormDr account while saving time.

HIPAA Compliant Form Submissions

HIPAA Compliant Form Submissions

Patients sign and submit forms securely to your online account. Review and manage completed patient forms before the appointment.

Encrypted PHI

Encrypted PHI ePHI

All PHI is encrypted in transit and at rest—while being submitted back to your account and at rest in our database. Protect sensitive data with fully encrypted patient submissions.

Book a Free Consultation

Schedule a consultation with us to learn more

FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. We help practices who:

  • Are having patients fill out paper forms during the appointment
  • Are emailing patients a PDF or Word Doc to print out, fill out, scan, and send back
  • Are spending time manually printing and scanning paper forms