Get the free Health History Form - Wesley Medical Center

Page 1 of 4 Health History Form Please fill this sheet out and bring it with you to your Prop Assessment Clinic visit and on the day of surgery. For more information to prepare for your surgery, visit

How to fill out health history form

1. Start by carefully reading the instructions provided on the health history form. This will help you understand what information is required and how to properly fill it out.
2. Begin by providing your personal information such as your full name, date of birth, address, and contact details. Make sure to double-check the accuracy of this information before proceeding.
3. Next, you will be asked to provide details about your medical history. This may include any pre-existing conditions, allergies, surgeries, or medications you are currently taking. Be as thorough as possible and include relevant dates and any additional information that may be deemed necessary.
4. In the next section, you may be asked about your family's medical history. This may include any hereditary conditions or diseases that run in your family. If you are uncertain about any details, it is recommended to consult with your immediate family members to ensure accuracy.
5. Proceed to fill out the section asking about your lifestyle choices, such as your diet, exercise routine, smoking or alcohol consumption habits, and any recent significant life events or stressors. This information helps healthcare professionals assess your overall well-being.
6. If the form includes a section regarding your immunization history, provide details about any vaccinations you have received, including the dates of administration.
7. Finally, review the entire form to ensure that all the required fields have been completed accurately. If there are any sections or questions that you are unsure about, seek clarification from a healthcare professional.

Who needs a health history form?

1. Patients visiting a new healthcare provider or clinic typically need to fill out a health history form. This helps healthcare professionals gain a comprehensive understanding of a patient's medical background, allowing them to provide proper diagnosis and treatment.
2. Individuals undergoing a surgical procedure or medical intervention may also be required to complete a health history form. This information helps surgeons and anesthesiologists assess the potential risks and make necessary preparations for the procedure.
3. Employers or insurance companies may request employees or policyholders to fill out a health history form as part of their record-keeping or assessment processes.
4. Students enrolling in certain academic programs or participating in athletic activities may be required to provide a health history form. This enables educational institutions to ensure the safety and well-being of their students.

Overall, the importance of a health history form lies in its ability to provide healthcare professionals with crucial information about an individual's medical background, guiding them in making informed decisions regarding diagnosis, treatment, and overall care.

For pdfFiller’s FAQs

What is health history form?

Health history form is a document that gathers information about an individual's medical history, including past illnesses, surgeries, medications, allergies, and family medical history.

Who is required to file health history form?

Health history form may be required to be filled out by patients when visiting a healthcare provider, by individuals applying for certain jobs or insurance policies, or by students enrolling in schools.

How to fill out health history form?

To fill out a health history form, individuals typically need to provide accurate and detailed information about their medical history, medications, allergies, surgeries, and family medical history.

What is the purpose of health history form?

The purpose of health history form is to provide healthcare providers, employers, and other relevant parties with important information about an individual's past and current health status, in order to make informed decisions about treatment, employment, or insurance coverage.

What information must be reported on health history form?

Information that may be required to be reported on a health history form includes personal medical history, medications, allergies, surgical history, family medical history, and lifestyle habits.

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