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15+ Medical History Form Templates

Featured Image: Medical History Form Examples

A medical history form is a vital tool for every doctor’s office or hospital.

In order for medical professionals to properly treat their patients, they need a SOAP Note along with a comprehensive medical history form that explains all the necessary details such as previous illnesses or conditions, allergies, current medication, and much more.

It’s not just doctors and nurses who can benefit from these; parents and school administrators can also use them to ensure they keep their children and students safe by being aware of any possible medical conditions.

Free Printable & Fillable Medical History Form Templates in Word & PDF

Not all medical history forms are created the same.

While all medical history forms usually ask for some of the same information, depending on the setting, you may require additional data to best assess the needs of patients.

Here are the different types of medical ones you can use in your healthcare facility.

For General Purpose

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A free general medical history form includes all the personal and family health treatment information and questions listed above.

Ideally, all medical facilities that treat them will want to utilize a general form to have a solid personal overview of their clientele.

Short & Simple

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Short medical history forms may often be found in offices or schools. These primarily may hold information such as name, date of birth, gender, family contact details, allergies, treatment form and may also include current health illnesses symptoms.

For Dental Treatment

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Dental health can be just as important and crucial to track as overall health.

A dental health history form is one for recording related information such as the patient’s dentist, any oral surgery, and any medication prescribed by their dentist.

Get one form template you like amongst these and help someone out you like.

Veterinary Use Sample

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Even your pets should have up-to-date medical history record templates.

If you are part of a veterinary care system, make sure you have owners fill out a form for their pets prior to receiving care.

Again, it’s very important to have only absolutely correct information in the medical history form, like about health history.

Don’t fill out anything that’s not 100% true as it could have an adverse impact at the time of an emergency. It’s better to be safe than sorry.

For First Aid

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When responding with help to one personal emergency treatment, it’s best to have a personal record of the treatment the patient has received earlier as well as the exact injury they may have incurred.

Also, a first aid medical form will let you monitor a patient’s health history form involving any emergencies.


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Also, certain patients will need their body mass index (BMI) tracked and recorded to better assess their health.

A BMI chart will give medical professionals an idea of possible causes for health issues.

What details should go in a medical history form?

When using a medical history form, you need to make sure it has enough information to give doctors, nurses, and other necessary professionals a detailed overview of your health history profile.

Here are a couple of the most crucial areas (besides name, gender, and date of birth) that must be included for a comprehensive medical history form:


Medical forms, especially the more comprehensive ones, can be complicated to understand.

Make sure to include detailed instructions on your medical form to help guide the patient with filling it out properly.

Also include information about a help line or someone they can contact to access certain information (such as for those who were adopted).

Current Address

Doctors’ offices and hospitals will often need to send you forms for you to sign and mail back.

Having an up-to-date address allows these to be sent to you quickly and efficiently without potential mishaps.

Telephone Number

A medical facility will need your telephone number if it needs to verify information or confirm appointments.

With a telephone number field, it is recommended that you add an indication of whether the number belongs to a mobile phone or landline, and whether it is a primary contact option.

Email Address

As we move further and further into the digital age, more people prefer to have their correspondence sent through email.

This reduces the chances of correspondence being lost or delayed.

Primary Insurance Information

By having medical insurance information, such as the name of the company and your membership number, readily available, you can streamline the process of delivering care and ensuring proper coverage.

Making sure this detail is included in Medical history form is very important as it helps the insurance company and relevant parties to quickly know all the details they would need to process things at their end.

Hence, always make sure you have up to date and correct information in your medical history form.

List Of Allergies

It is necessary for medical history forms to include a field for them to fill in a list of allergies.

This helps doctors know to avoid prescribing medicine that can trigger a possibly dangerous reaction.

List Of Prescription Medication

Certain medicines cannot be mixed with each other and can have adverse effects if taken at the same time.

Your medical history form should have a field where they can list the medications they are currently taking.

List of past conditions or diseases in Medical History Form:


One of the most important sections on a medical history form is the actual medical history of the patient.

You will want to ask if the patient has a health history of the following diseases or medical information of conditions:

  • Anxiety or depression
  • Substance abuse
  • Asthma
  • Cancer
  • Diabetes
  • Head injury
  • High blood pressure
  • Sexually transmitted diseases
  • Sleep problems

Emergency Contacts

In the event of an emergency, a medical facility may need to reach out to a patient’s emergency contact, typically a relative or close friend.

Always include an emergency contact field on any medical history form.

Family Medical History

Some diseases and medical conditions are hereditary, which is why it’s important for patients to specify their families’ medical histories on forms.

Some form fields that should be on the medical form include a request for family history of diabetes, hypertension, and cancer.

The form should also ask about ages older family members were when they passed away, as well as the cause of death.

HIPAA Disclosure

Patients are entitled to privacy regarding their health and medical histories. Include a HIPAA disclosure on your medical history forms so that patients know their information is private and secure.

Without a HIPAA disclosure, you can violate both the trust of your patient as well as multiple laws depending on your country.

Additional Resources

You can use a medical history form pdf/word to give patients additional information on health-related topics.

Add a section on the form that directs patients where they can access reliable resources regarding their health.

If your facility has an online portal, include this in the additional resource section and ask patients to include their email address so that they can register.

This can help them stay in touch with their health professional, view past medical information templates, and access trustworthy medical resources or medications.

Signature And Date

Two of the most important yet often overlooked fields on a medical history form are the patient signature and date that they signed on the templates.

This makes the form a binding document that has been read and acknowledged by the patient.

Always include a family signature and date section on the pdf/word for legal and compliance reasons.


Medical history forms serve many beneficial purposes. Medical care facilities such as labs, hospitals, and doctor’s offices use them to better understand their patients and thus deliver top-quality, safe service.

However, other facilities such as schools and even offices can benefit from having medical history forms on file to better care for students, staff, and other personnel.

Go ahead share and use the ones listed above.

Make sure when you get and use a medical history form, you are filling all the correct detail in the history form as sometimes we tend to get lazy and fill it up randomly just to prevent ourselves from the hassle of taking out the documents and filling in details.

So, its important that you don’t let that happen as that medical history form would practically be useless without absolutely correct details.

Sara Cemin

Hi, I am Sara Cemin and I’m all about designing meaningful stuff such as templates, Forms that are required in various activities of business and academics.I take a research-driven approach to cumulate the best templates on any topic,