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.

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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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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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Medical Consent Form for Child

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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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Grief Evaluation for Children & Teenagers (17 and Under)

Collect valuable information concerning your patient’s grief experience and daily life. Review this information prior to the appointment to guide the conversation.
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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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Give patients the freedom to complete the adult ADHD self-report checklist at the most comfortable an convenient time, with a phone, tablet, or computer. Information is submitted securely and is ready for your review before the appointment.

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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.
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Patient Satisfaction Survey

Follow up with your patients by sending this patient satisfaction survey. Your patients are your customers and patient satisfaction is critical to ensuring the success of your practice.

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

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Configure a HIPAA compliant form kiosk page to display new patient registration forms, consent forms, and more.

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HIPAA Compliant Online Intake Forms

Emailing new patient intake forms risks the interception of PHI. FormDr is HIPAA compliant, all patient data is encrypted in transit and rest. A Business Associate Agreement is included with your account.

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Account Audit Logs

Keep a detailed record of your account and export your history as a CSV Excel file or Google Sheet. Quickly export every event from your account; or, select a date range or user’s history to export.

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