Get Medical History Form - Wichita Urology

Completing the Medical History Form for Wichita Urology is an essential step in providing comprehensive care. This guide will walk you through each section of the form to ensure that you can fill it out accurately and efficiently.

Follow the steps to complete your Medical History Form online.

1. Press the 'Get Form' button to access the Medical History Form, making sure it opens in your selected editor.
2. Begin by entering your personal details at the top of the form, including your name, date of birth, and age.
3. Provide the names of your family doctor, city of practice, and any referring doctors or other medical professionals caring for you.
4. In the 'Reason for Visit/Chief Complaint' section, briefly describe the primary reason for your appointment.
5. Complete the 'Patient Past Medical History' section by circling all applicable medical conditions you have experienced, following the prompts provided.
6. List any current medications along with dosages in the specified section to inform your medical provider about your ongoing treatments.
7. Indicate any known medication allergies and specify the type of reaction you have had to each.
8. Provide details of any surgeries you have had by checking 'Yes' or 'No' for each procedure listed in the 'Surgical History' section.
9. Fill in your social history, noting your smoking status, alcohol use, occupation, and any illicit drug use.
10. Complete the family history section by indicating any significant family health issues relevant to your medical care.
11. Finally, ensure you sign and date the form to confirm all information is accurate before proceeding to save or share.

Begin filling out your Medical History Form online today to ensure your information is prepared for your appointment.