Family Medical History Form
Asks about cancer history (by type), cardiovascular disease history, and diabetes history. Built for primary care preventive health visits.
- Questions
- 10
- Page
- 1
- Time
- about 3 min
Includes
- Conditions checklist
Your practice
Family Medical History Form
Live preview. Tap through it like a patient.
Who it is for
- Primary care preventive health visits
- Genetics counseling and risk assessment
- Oncology screening programs
- New patient comprehensive intake
What's inside
- Full NameText · Required
- Cancer History (by Type)Long Text
- Cardiovascular Disease HistoryLong Text
- Diabetes HistoryLong Text
- Neurological ConditionsLong Text
- Autoimmune DisordersLong Text
- Mental Health HistoryConditions
- Relative Details (Who/Age of Onset)Long Text
- Adopted/Unknown Family HistoryLong Text
- Date of BirthDate
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Family Medical History Form, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
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Questions
Send it before the visit, so patients arrive ready.
Add the Family Medical History Form to your account and make it yours in a few minutes.
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