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Medical History Questionnaire

Asks about primary care physician, do you have any known allergies, and list of current medications. Built for any medical practice onboarding new patients.

Questions
14
Page
1
Time
about 4 min

Includes

  • E-signature
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Your practice

Live preview. Tap through it like a patient.

Who it is for

  • Any medical practice onboarding new patients
  • Annual health record updates
  • Pre-operative medical clearance
  • Specialist referral documentation

What's inside

  1. Full NameText · Required
  2. Date of BirthDate · Required
  3. Primary Care PhysicianText
  4. Do you have any known allergies?Long Text · Required
  5. List of Current MedicationsLong Text · Required
  6. Do you have a history of the following conditions?Checkbox · 9 choices · Required
  7. Have you had any surgeries?Long Text
  8. Are you currently under any medical treatment?Long Text
  9. Do you use any assistive devices (e.g., glasses, hearing aids)?Checkbox · 6 choices
  10. Do you smoke?Toggle

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Medical History Questionnaire, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Medical History Questionnaire for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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