Medical History Questionnaire

The Medical History Questionnaire is a comprehensive health background document that captures a patient's complete medical story. It covers past and present medical conditions organized by body system, current medications with dosages and frequencies, allergy documentation with reaction types, surgical history with dates and outcomes, and family medical history for hereditary condition screening.

This form is essential for new patient onboarding across all specialties. It provides the clinical foundation that providers need to make informed treatment decisions, identify potential drug interactions, and screen for hereditary disease risk. The review of systems approach ensures no major health area is overlooked.

The questionnaire uses a smart checklist format that makes it easy for patients to complete without medical knowledge. Common conditions are listed by category (cardiovascular, respiratory, gastrointestinal, neurological, etc.) with the ability to add free-text details. Social history covers tobacco, alcohol, recreational drug use, exercise habits, and occupation. This template can be used standalone or combined with any specialty intake form.