Medical History Form

Who this template is for

Medical History Form is built for teams with a niche process that generic forms don't cover who need to capture reproducible detail on first contact.

• Teams with a niche process that generic forms don't cover working in healthcare, legal & specialized.
• Teams who need to capture reproducible detail on first contact without writing code or paying for a custom build.
• Anyone replacing requests that need three replies before work can start with one structured record per enquiry.
• Respondents are the specific group this workflow serves — the form asks them 23 questions across 5 screens.
• Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of requests that need three replies before work can start and turns each submission into a record your team can act on immediately.

• 9 questions are required, so submissions arrive complete instead of needing a follow-up email.
• It records a signature you can keep as proof of agreement.
• It pins the request to a specific date.
• It allows multiple selections without free text.
• It captures a numeric value you can filter and sort on.
• Conditional logic hides 4 questions until they are relevant — shorter forms convert better than long ones.
• Splitting the form across 5 pages keeps each screen short and shows respondents how much is left.
• Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1. 1Press “Use this template” — a fresh copy of Medical History Form lands in your workspace, ready to edit.
2. 2Rename or delete any question, and change what is required. Nothing here is fixed.
3. 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4. 4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5. 5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 4 conditional rules ship with it.

• Features conditional validation: if “Are you currently taking any medication?” is Yes, “Medication, dose and who prescribed it” becomes mandatory before the form can be sent.
• Features conditional validation: if “Do you have any allergies?” is Yes, “Allergy and the reaction it causes” becomes mandatory before the form can be sent.
• Features advanced show logic: if “Have you had surgery or been admitted to hospital?” is Yes, the form dynamically exposes “Procedure, hospital and approximate date”. Otherwise that question never appears.
• Features advanced show logic: if “Do you smoke or vape?” is Yes, the form dynamically exposes “Roughly how much per day”. Otherwise that question never appears.
• All 4 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.