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Medical history form templates
48 free medical history form templates you can preview without an account. They span Healthcare & Clinical, Healthcare, Legal & Specialized, Fitness, Wellness & Coaching use cases and average around 18 questions each, so most teams find one that only needs light editing. Open any template to see every question it asks, the conditional logic it ships with, and the layouts it supports — then publish it on your own link, embed it on your site, or share it by QR code. Submissions land in your HelloForms inbox with email notifications, exports and analytics from the first response.
48 templates for “medical history form”
Medical History Form
Collect conditions, medication, allergies, surgeries and family history before an appointment.🩺 Healthcare, Legal & Specialized23 questionsMedium length — 23 questions across 5 pages.View template
Medical History Update Form
The short annual refresh: what changed since the last visit, without repeating full intake.🩺 Healthcare, Legal & Specialized12 questionsShort form — 12 questions on a single page.View template
Medical Referral Form
Send patients to specialists with everything attached — reason, history, urgency and reports.🩺 Healthcare, Legal & Specialized13 questionsShort form — 13 questions across 2 pages.View template
Patient History Form
Full three-part medical history: personal and family background, systems review, lifestyle and medication, ready before a first consultation.🏥 Healthcare & Clinical24 questionsMedium length — 24 questions across 3 pages.View template
Patient Intake Form
Medical history and background disclosure with a compliance focus.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 3 pages.View template
Medical Equipment Loan Request Form
Medical equipment loan request naming the equipment needed, reason, delivery details, and how long the equipment is expected to be needed.🏥 Healthcare & Clinical12 questionsShort form — 12 questions on a single page.View template
Chiropractic Intake Form
New patient intake for chiropractic care: the complaint and its history, previous manual treatment, general health screening, and consent to treat.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View template
Dental New Patient Intake Form
Dental history, insurance and consent in one pre-visit pack for new patients.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 4 pages.View template
Fall Risk Assessment Form
Fall risk assessment recording fall history, mobility and balance, medications, vision, and home hazards, with a plan for follow-up and referrals.🏥 Healthcare & Clinical16 questionsShort form — 16 questions across 3 pages.View template
Therapy Client Intake Form
Counselling intake covering history, goals, medication and emergency contact.🩺 Healthcare, Legal & Specialized19 questionsShort form — 19 questions across 4 pages.View template
New Patient Registration Form
Complete new-patient record: contacts, history, medications, insurance and consents.🩺 Healthcare, Legal & Specialized20 questionsShort form — 20 questions across 3 pages.View template
Veterinary New Patient Intake Form
Register a new animal patient with owner, species and medical history.🐾 Pets & Veterinary27 questionsMedium length — 27 questions across 4 pages.View template
Child Medical Information Form
Build a health picture for the room: conditions, medication, sleep, mobility and the doctor's details.🧸 Daycare Forms19 questionsShort form — 19 questions across 3 pages.View template
Nutrition Coaching Questionnaire
Food history, habits, medical flags and goals: the intake behind a safe nutrition plan.🧘 Fitness, Wellness & Coaching17 questionsShort form — 17 questions across 2 pages.View template
Personal Training Health Assessment
PAR-Q style medical history plus goals, training history and availability.🧘 Fitness, Wellness & Coaching16 questionsShort form — 16 questions across 3 pages.View template
Coaching Intake Form
Everything you need before session one: goals, history, obstacles and working style.🧘 Fitness, Wellness & Coaching16 questionsShort form — 16 questions across 2 pages.View template
Spa Intake & Health History Form
Treatment-safe intake: conditions, contraindications, pregnancy and pressure preferences.💇 Beauty, Salon & Spa17 questionsShort form — 17 questions across 2 pages.View template
Dermatology Patient Intake Form
Dermatology intake covering the reason for the visit, how long it has been present, skin history, sun exposure and current skincare products used.🏥 Healthcare & Clinical15 questionsShort form — 15 questions across 2 pages.View template
Orthodontic Consultation Form
One-page form for a first orthodontic consultation: main concern, prior treatment, jaw symptoms, and the times that suit an initial appointment.🏥 Healthcare & Clinical12 questionsShort form — 12 questions on a single page.View template
Patient Referral Form
Clinician-to-clinician referral with the reason for referral, relevant history, what has been tried, urgency and what the referrer is asking for.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View template
Caregiver Assessment Form
Caregiver assessment recording caregiving hours and tasks, existing support, personal impact, and the services a caregiver wants more information about.🏥 Healthcare & Clinical14 questionsShort form — 14 questions across 2 pages.View template
Immunization Consent Form
Consent for a named vaccination: eligibility and screening questions, previous reactions, information provided, and the signature with date.🏥 Healthcare & Clinical19 questionsShort form — 19 questions across 2 pages.View template
Eye Exam Intake Form
Pre-exam optometry intake: recent vision changes, current glasses or lenses, screen and driving needs, eye history, and relevant general health.🏥 Healthcare & Clinical17 questionsShort form — 17 questions across 2 pages.View template
Mental Health Intake Form
Three-page intake for mental health services: presenting concerns, history and support, risk and safety questions, and what the client wants from therapy.🏥 Healthcare & Clinical25 questionsMedium length — 25 questions across 3 pages.View template
Showing 24 of 48 templates
All 48 medical history form templates
- Medical History Form
- Medical History Update Form
- Medical Referral Form
- Patient History Form
- Patient Intake Form
- Medical Equipment Loan Request Form
- Chiropractic Intake Form
- Dental New Patient Intake Form
- Fall Risk Assessment Form
- Therapy Client Intake Form
- New Patient Registration Form
- Veterinary New Patient Intake Form
- Child Medical Information Form
- Nutrition Coaching Questionnaire
- Personal Training Health Assessment
- Coaching Intake Form
- Spa Intake & Health History Form
- Dermatology Patient Intake Form
- Orthodontic Consultation Form
- Patient Referral Form
- Caregiver Assessment Form
- Immunization Consent Form
- Eye Exam Intake Form
- Mental Health Intake Form
- Pediatric Intake Form
- Care Plan Review Form
- Dental Treatment Plan Consent Form
- Lab Test Requisition Form
- Medication Review Form
- Pharmacy Transfer Request Form
- Physiotherapy Intake Form
- Pre-Surgery Assessment
- Records Release Form
- Substance Use Screening Form
- Consent to Treatment Form
- Discharge Follow-Up Form
- Nurse Triage Form
- Nutrition Intake Form
- Occupational Health Form
- Patient Satisfaction Form
- Quick Cancellation Form
- Research Study Screening Form
- Quick Records Request
- Sports Physical Examination
- Dental Registration Form
- Patient Intake Questionnaire
- Quick Clinic Feedback
- Quick Patient Check-In
Frequently asked questions
- Are these medical history form templates free?
- Yes. Every medical history form template on this page is free to preview and free to use on the Starter plan, including your own public form link and email notifications on each submission.
- Which medical history form template should I start with?
- Medical History Form is the closest match for this search — it has 23 ready-made questions. If it asks for more than you need, delete any question in the builder; nothing is locked.
- Can I change the questions on a medical history form template?
- Every question is editable. Rename labels, mark fields required or optional, add conditional logic so follow-up questions only appear when they are relevant, and restyle the form to match your brand.
- How do I collect responses?
- Publish the form and share its link, embed it in a page, or print its QR code. Responses appear in your inbox in real time and can be exported to CSV or PDF at any time.
Related templates
More templates that fit this search.
Patient Registration Form
Register a new patient with contacts, insurance, consent and their medical basics.🩺 Healthcare, Legal & Specialized25 questionsMedium length — 25 questions across 5 pages.View template
Patient Encounter Form
The visit record clinics bill from — reason, diagnosis codes, services and follow-up in one sheet.🩺 Healthcare, Legal & Specialized13 questionsShort form — 13 questions across 2 pages.View template
HIPAA Patient Consent Form
Patient authorization for treatment, billing and named disclosures, with an expiry date and revocation notice.🩺 Healthcare, Legal & Specialized16 questionsShort form — 16 questions across 4 pages.View template
Workplace Incident Report Form
Capture what happened, who was hurt, witness accounts and the corrective action after a workplace incident.🩺 Healthcare, Legal & Specialized30 questionsMedium length — 30 questions across 4 pages.View template
Dental Clearance Form
Dental fitness confirmed before surgery or treatment — findings, clearance status and dentist sign-off.🩺 Healthcare, Legal & Specialized11 questionsShort form — 11 questions on a single page.View template
Telehealth Appointment Request
Virtual visit booking with symptom summary and a quick tech readiness check.🩺 Healthcare, Legal & Specialized10 questionsShort form — 10 questions on a single page.View template