Free Medical History Form Template | FormMaker
Create a free online medical history form. Collect conditions, medications, allergies, surgeries and family history in one place. No signup required.
- Category
- Medical
- Fields
- 9
- Price
- Free
Live preview — try it out
About this template
A medical history form gives a clinician a complete picture of a patient's health background before care begins — conditions, medications, allergies, past procedures, and relevant family history. This free template lets patients complete it online at their own pace, producing accurate, legible records and saving time at the appointment.
Tips for better responses
- Give roomy text fields so patients can list conditions and medications fully.
- Always include an allergies question — it's the field that prevents the worst mistakes.
- Ask patients to update the form each year rather than filling a blank one every visit.
- For clinical use, host on a HIPAA-compliant setup and store responses securely.
What's included
- Patientsection
- Full nameentry
- Date of birthentry
- Medical historysection
- Current and past medical conditionseditor
- Current medicationseditor
- Allergieseditor
- Past surgeries or hospitalizationseditor
- Family medical historyeditor
- Lifestylesection
- Do you smoke or use tobacco?dropdown
- I confirm this medical history is accurate to the best of my knowledge.yesno
Frequently asked questions
- Is the medical history form template free?
- Yes. Every template is free to use. The free plan covers 3 forms and 100 submissions a month, with no credit card required.
- What fields are included?
- 9 fields: Full name, Date of birth, Current and past medical conditions, Current medications, Allergies, Past surgeries or hospitalizations, and more. You can add, rename, reorder or delete any of them.
- Do I need to know how to code?
- No. You edit the fields in a drag-and-drop builder and publish with one click. Embedding it on your own site is a copy-paste snippet.
- Where do the responses go?
- Straight to your FormMaker dashboard, where you can read them individually, search across them, or export the lot to CSV. You can also push them to Google Sheets, Slack or Zapier.
Ready to use this template?
Start free — 3 forms and 100 submissions a month, no credit card.
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