Get Health History Questionnaire 2020-2025

Completing the Health History Questionnaire online is a crucial step in helping your health care provider understand your medical history. This comprehensive form consists of various sections that gather details about your medical concerns, previous conditions, and lifestyle choices.

Follow the steps to accurately complete your Health History Questionnaire.

1. Click ‘Get Form’ button to access the questionnaire and open it in the editor.
2. Begin by entering your name and the date at the top of the form. This will help to identify your submission.
3. In the first section, indicate who referred you to the practice by circling the appropriate option and providing a name if applicable.
4. State your main reason for the visit and any additional health concerns in the designated areas.
5. Complete the health goals section, reflecting on what you aim to achieve concerning your health in the next year.
6. Rate your health on the scale provided by circling one of the options: excellent, good, fair, or poor.
7. List any healthcare providers you see regularly, including their specialties, in the provided spaces.
8. Detail any medical suppliers you use, as well as a comprehensive list of all medications you currently take, including prescriptions and over-the-counter products.
9. Record your allergy information and reaction details if applicable, or check 'none' if you have no known allergies.
10. Enter your immunization history, providing years where known for each vaccine listed.
11. Fill out the health maintenance screening tests section, providing dates and results where applicable.
12. Complete the personal medical history section, indicating any conditions you currently have or have had in the past.
13. Review and check off any surgical and procedure history that applies to you.
14. Provide family history information, indicating any significant medical diseases that may be relevant.
15. Review and fill out the health issues section, detailing your tobacco use, alcohol consumption, and any relevant lifestyle choices.
16. Complete the safety questions and provide any social documentation required.
17. Conclude with your socioeconomic information, including occupation, marital status, and education.
18. If applicable, fill out the women’s health history section, providing information about pregnancies and menstrual history.
19. Once all sections are complete, review your answers for accuracy and clarity.
20. Save your changes, and choose to download, print, or share the completed form as needed.

Start completing your Health History Questionnaire online today for a better health care experience.