Family Health History Template

A family health history template is a readymade document which is drafted so that it can be used at health centres or hospitals to enquire about the family health history of a person. These kinds of templates have prewritten content which can be used as it saves a lot of time and provides an outline of the family health history document. The nature of these templates is such that they can be customised easily by users so that they can serve their individual purpose and requirement. Infact this way, such templates save energy as well and are quite inexpensive. Any family health history template consists of points such as names of family members, diseases or ailments, cure, medicine used etc… If you want a sample of your desired health template, then you can get it on this website.

“You can Download the Free Family Health History Template form, customize it according to your needs and Print. Family Health History Template is either in MS Word, Excel or in PDF.”

Sample Family health history template:

Family health history template

Download Family health history template

Name: _______________ [mention here the name of the person filling the family health history document]

Age: _____________ [mention here the age of the person]

Date of birth: ___________/___________/______________

Address: _______________ [mention here the address of the person]

Contact number: _____________ [mention here the contact number of the person]

Number of family members: ____________ [mention here the number of family members of the person]

Fill the following columns with appropriate information:

Name                    Age                   Relation

[Fill these columns with the information of the immediate family members.

Fill the following columns with health history:

Name              Medical history      Time for cure              Doctor consulted

[Fill these columns with appropriate information of the family members of the person]

Q1. Do any of your family members suffer from High blood pressure problem? [This question is asked to know high BP history of family]


Q2. Do any of your family members suffer from diabetes? [This question is asked to know diabetes history of family members of the person]

Q3. Is there any specific piece of medical related information which you would like to add? [This question is asked to take any additional information from the person]

Category: Health Templates

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