formisoft

Travel Health History Form

Asks about travel destination(s), travel dates, and type of travel. Built for pre-travel consultation and prophylaxis planning.

Questions
14
Pages
2
Time
about 4 min

Includes

  • E-signature
  • Medication list
  • Conditions checklist
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Your practice

Travel Health History Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Pre-travel consultation and prophylaxis planning
  • Post-travel fever and illness evaluation
  • Occupational health international assignee clearance
  • Infectious disease endemic exposure assessment

What's inside

Page 1 · Your information

  1. Full NameText · Required
  2. Travel Destination(s)Long Text
  3. Travel DatesDate
  4. Type of TravelLong Text
  5. Activities & Exposure RisksLong Text

Page 2 · Additional details

  1. Existing Medical ConditionsConditions
  2. Current MedicationsMedications
  3. Post-Travel Symptom ScreenLong Text
  4. Symptom Onset DateDate
  5. Fever Pattern DescriptionLong 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 Travel 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 Travel 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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