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Occupational Health History Form

Asks about current employer & job title, employment history, and hazardous substance exposures. Built for occupational medicine clinic new patient evaluation.

Questions
14
Pages
2
Time
about 4 min

Includes

  • E-signature
  • Conditions checklist
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Your practice

Occupational Health History Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Occupational medicine clinic new patient evaluation
  • Employer-mandated health surveillance programs
  • Workers' compensation injury documentation
  • Return-to-work and fitness-for-duty assessments

What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Current Employer & Job TitleText
  3. Employment HistoryLong Text
  4. Hazardous Substance ExposuresLong Text
  5. PPE Usage HistoryLong Text

Page 2 · Additional details

  1. Respiratory Surveillance ResultsLong Text
  2. Audiometric Testing HistoryLong Text
  3. Ergonomic Risk FactorsLong Text
  4. Current Work RestrictionsLong Text
  5. Fitness-for-Duty StatusLong Text

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 Occupational Health History Form, 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.

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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 Occupational Health History Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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