Surgical History Form
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Surgical History Form
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The Surgical History Form is a focused template for documenting a patient's complete surgical background. Unlike the general medical history form, this template dives deep into surgical-specific details: every prior procedure with dates, surgeons, and facilities; anesthesia type and any adverse reactions; surgical complications including infections, bleeding, and wound healing issues; and implanted devices or hardware.
This form is critical for pre-operative planning and surgical clearance. Anesthesia history is documented with specificity -- previous reactions to general, regional, or local anesthesia, malignant hyperthermia family history, and airway management difficulties. Blood transfusion history includes previous transfusions and any transfusion reactions.
The template also captures current anticoagulant and antiplatelet medication use, which is essential for surgical planning and perioperative medication management. Post-surgical recovery patterns help set expectations for upcoming procedures. This form is used by surgical practices, pre-admission testing centers, and anesthesiology departments across all surgical specialties.
What's included
- Complete surgical history with dates and details
- Anesthesia history and adverse reactions
- Surgical complication documentation
- Implanted device and hardware registry
- Blood transfusion history and reactions
- Current anticoagulant documentation
- E-signature capture
Who uses this template
- Pre-operative assessment clinics
- Surgical practices across all specialties
- Anesthesiology departments
- Pre-admission testing centers
All form fields
10 fields across 2 pages. Customize any field after signing up.
How to use the Surgical History Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Surgical 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 Surgical 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 Surgical History Form HIPAA compliant?
Yes. All Formisoft templates, including the Surgical 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 Surgical 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 Surgical History Form for your practice. Set up in minutes.
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