Template: Medical IntakeComprehensive Health History and Current Health Status Form Form TemplateUse This Template Capture a detailed health history and current health status for new employees.This is a preview of the template. Click here to use it.Full Name *Date of Birth *Position/Job Title *Have you had any of the following medical conditions? (Check all that apply) Heart DiseaseHigh Blood PressureDiabetesAsthmaSeizuresAllergiesChronic PainMental Health ConditionsSurgery HistoryOther (please specify)If you selected 'Other', please specify Are you currently taking any medications? *YesNoIf yes, please list your medications Do you have any known allergies? (e.g., food, medication, environmental) *Have you had any surgeries or hospitalizations in the past five years? *YesNoIf yes, please provide details Do you have any physical or mental conditions that may require workplace accommodations? *YesNoIf yes, please describe the accommodations needed Current Health Status (e.g., general well-being, current issues) *Do you exercise regularly? YesNoIf yes, describe the type and frequency of exercise Do you smoke or use tobacco products? YesNoDo you consume alcohol? YesNoAdditional Comments or Concerns Signature of Employee *Sign HereUse This Template