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Social History Questionnaire

Asks about tobacco use history, alcohol use (AUDIT-C), and recreational drug use. Built for primary care comprehensive health assessment.

Questions
14
Pages
2
Time
about 4 min
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Your practice

Social History Questionnaire

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Primary care comprehensive health assessment
  • Behavioral health intake and substance use screening
  • Public health social determinants of health screening
  • Preventive medicine lifestyle risk factor documentation

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What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Tobacco Use HistoryDropdown · 4 choices
  3. Alcohol Use (AUDIT-C)Long Text
  4. Recreational Drug UseLong Text
  5. Occupation & EmployerText

Page 2 · Additional details

  1. Dietary Patterns & RestrictionsLong Text
  2. Living SituationDropdown · 6 choices
  3. Food Insecurity ScreeningLong Text
  4. Transportation BarriersLong Text
  5. Intimate Partner Violence ScreenLong 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 Social 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.

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Questions

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.

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.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. 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.

Yes. The Social History Questionnaire works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Social History Questionnaire to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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