Health History Questionnaire Template

Health history questionnaire template is a ready to use document which is drafted for evaluation purpose of many people which lets organisations come to a common conclusion about general health conditions of the area. Such templates are useful as they come with prewritten questions whereas spaces for answers are left for organisations to write themselves according to personal need and requirement. The main part of the content needed is already present and users just need to add their personal details so as to personalise the document. The  main use of such templates is for those organisations who wish to save their time which would have been spent on drafting the questionnaire form the scratch. These templates have well detailed structures and can be trusted as far as their authenticity is concerned.

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

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Sample Health history questionnaire template

Health history questionnaire template

Download Health history questionnaire template

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

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]

Q1. What do you think about your general health condition? [This question is asked to know about general health condition of the person]

_______________ [provide space for answer]

Q2. Have you ever been diagnosed with any medical condition which was treated later [This question is asked to know health history]

________________________ [provide space for answer]

Q3. Do you have any allergies or infections from any particular food items? [This question is asked to know about allergic reaction history]

____________________ [provide space for answer]

Q4. Do you suffer from diabetes, high blood pressure or any other such common medical ailments? [This question is asked to know about common medical conditions]

______________________ [provide space for answer]

Q5. Have you ever been hurt in an accident which has an ongoing effect? [This question is asked to know about accidents]

_________________ [provide space for answer]