Family Medical History Form
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Family Medical History Form
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The Family Medical History Form provides a structured approach to documenting hereditary disease risk across multiple generations. It covers first-degree relatives (parents, siblings, children) and second-degree relatives (grandparents, aunts, uncles) with specific attention to conditions with known genetic components: cancer (by type and age of onset), cardiovascular disease, diabetes, neurological conditions, autoimmune disorders, and mental health conditions.
The form is organized by condition category rather than by relative, making it efficient for patients to complete. For each positive family history, patients indicate which relative was affected, age of onset, and outcome. This structured format makes it easy for providers to assess cumulative risk and determine appropriate screening recommendations.
This template is valuable for primary care, genetics counseling, oncology risk assessment, and preventive health programs. It helps identify patients who may benefit from enhanced screening protocols (e.g., early colonoscopy for family colon cancer history) or genetic testing referrals. The form can be updated periodically as family health information changes.
What's included
- Cancer history by type with age of onset
- Cardiovascular and metabolic disease screening
- Neurological and autoimmune condition history
- Mental health family history
- First and second-degree relative documentation
- Adopted/unknown history accommodation
- Medical conditions checklist
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 2 pages. Customize any field after signing up.
How to use the Family Medical History Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Family Medical History Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the Family Medical History Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 10 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the Family Medical History Form HIPAA compliant?
Yes. All Formisoft templates, including the Family Medical History Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
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?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
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.
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