Health History Form Template

A health history form template is a document which serves the purpose of a health history form which has to be answered by people at health centres. These kinds of templates come prewritten and only need to be customised by the organisations which are using the forms for their personal use and requirement. Any health history form can be in the form of questionnaires which are either objective or subjective in nature. These questions are related to the history of the family as far as health is concerned. These documents consist of those points through which a medical centre can analyse the result of the entire family’s history of health and come to a conclusions related to it. These documents are customisable in nature and are used pretty widely.

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

Sample Health history form template:

Health history form template

Download story form template

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

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

Date of birth: ___/_______/_____ [Give age in dd/mm/yy format]

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

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

Email address: __________ [mention the email address of the person]

Tell about the medical condition which you were previously diagnosed with and which is still prevalent [This is to know about any ongoing medical conditions if the person]

________________________________________

Tell about the medical condition which was diagnosed and then treated [This is to know about the overall health history of the person]

________________________

Give a detail about any allergies or infections from any particular food items [This is to know about allergic reaction history of the person]

____________________

Tell about any hereditary medical condition situation in your family which you might get too? [This is asked to know health history of family of the person which he too can be affected by]

______________________

Tell about any physical condition or a wound which still hurts? [This is asked to know about any physical problems or pain]

_________________

 

Healthcare Proposals 

Category: Health Templates

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