Assign from

More about Patient Medical History Form

When new patients join your practice or existing patients visit your office, the intake process can get pretty messy pretty quickly. Build efficiency into your processes with a simple and convenient online data collection tool.

The Patient Medical History Form is hardly revolutionary in itself. For as long as medical providers have been practicing, there has always been a need to collect background data to ensure that patients receive the best possible care. From allergies and past illnesses to hereditary concerns, the more knowledge a patient can transfer to the provider, the better. Moving this process online improves both efficiency and data quality, ensuring that nothing is lost along the way.

Whether this form is delivered in advance via email, or in person on tablet, mobile, or kiosk, the long lists of checkboxes on piles of paper are no longer required. Implement a streamlined process for collecting patient medical history and your patients and colleagues will thank you.


Emergency Department Satisfaction Survey

This survey seeks to gather information from patients who were recently in the hospital's emergency department. The survey puts special emphasis on timeliness, ease, and comfort of treatment.

Read More


Clinic Evaluation Survey

This highly customizable form is designed to provide valuable feedback on a patient's experience at a medical clinic.

Read More


Dental Office Evaluation

Following a patient's visit to a dental office, gain quick insight into the quality of their experience.

Read More

Please email us at or fill out this form and we will contact you shortly.

 Yes No


Please call +1 (800) 646-0520 or fill out this form and we will contact you shortly.