Family Medical History Form
Medical History

Family Medical History Form

1 page•10 fields
Editable templateCustomize in minutes

Form Preview

formisoft.com/f/family-history
Family Medical History Form

Family Medical History Form

Page 1 of 1

Full Name
Jane Martinez
Cancer History (by Type)
Enter details here...
Cardiovascular Disease History
Enter details here...
Diabetes History
Enter details here...
Neurological Conditions
Enter details here...
Autoimmune Disorders
Enter details here...
Mental Health History
Diabetes
Hypertension
Asthma
Heart Disease
Relative Details (Who/Age of Onset)
Enter details here...
Adopted/Unknown Family History
Enter details here...
Date of Birth
03/15/1985
Submit
Use this template

Sign up and start customizing in minutes.

Start with the Family Medical History Form template and tailor it to your practice. It includes 10 editable fields across 1 page. Included questions: Full Name, Cancer History (by Type), Cardiovascular Disease History, Diabetes History. The full field list below shows what you will get when you add this template to your account.

Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.

What's included

  • Full Name
  • Cancer History (by Type)
  • Cardiovascular Disease History
  • Diabetes History
  • Neurological Conditions
  • Autoimmune Disorders
  • Mental Health History
  • Relative Details (Who/Age of Onset)
  • Adopted/Unknown Family History
  • Date of Birth

Who uses this template

  • Primary care preventive health visits
  • Genetics counseling and risk assessment
  • Oncology screening programs
  • New patient comprehensive intake

All form fields

10 fields across 1 page. Customize any field after signing up.

Full NameText
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

How to use the Family Medical History Form

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Family Medical History Form from the template library. Review the included questions, customize your fields, and preview the form before sharing it.

Setup steps

  1. 1Choose the template. Find the Family Medical History Form in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 10 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

How does Formisoft protect responses?

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.

Does this template work on mobile devices?

Yes. The Family Medical History Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

Start with this template

Sign up and start customizing the Family Medical History Form for your practice. Set up in minutes.

Related templates

Family Medical History FormUse this template