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.

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Give your 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.

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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.

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.
HIPAA Compliant File Upload

File Attachment Upload

With file upload fields, your patients can upload their prescriptions, x-rays, medical records, insurance card photos and more with their form submission.

Workflow Automation

HIPAA Compliant Workflow Automation

FormDr’s drag-and-drop workflow builder lets you create custom automation in minutes—no coding or technical expertise needed. Simply drag tasks, triggers, and actions into place to design seamless workflows that fit your practice’s needs.

EHR & EMR Integration

Share patient data back and forth from FormDr to common EMR systems seamlessly with EHR Integrations.

Stripe Payment Processing

Quickly and efficiently collect patient payments using a PCI compliant payment processing widget with reporting capabilities and the easy customizations you expect from FormDr.

Book a Free Consultation

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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