Medical History Form

Use our free medical history form template to collect information about a patient’s prior conditions and care. Easily customize it for your medical practice. Add, remove and change fields. Use Zapier, Microsoft Power Automate or webhooks to integrate data with your EMR systems. And embed the form directly into your website to make new patient registration fast and simple. Please note that our Enterprise plans can be made HIPAA compliant.

Medical History Form

Use our free medical history form template to collect information about a patient's health online.

Use This Template