Patient Medical History Form

Number of pages 5 Number of questions 20 Number of times used 3.6k+

Time to complete 7 minutes(approx.)

Save patient time by an efficient collection of personal information and medical history, ensuring accurate records and realtime updates.
Survey Template

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.

Patient Medical History Form templates are hardly a revolutionary idea. 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.




Or, click sign up free button to conduct Patient Medical History Form


Download our amazing mobile app for free and get started! You may access our full browser version on the web, too.


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.



Company Size


Customer Since

Read more

Typical Rave Review