Form preview

Get the free Health History

Get Form
This document is used to gather a patient's health history, including past medical conditions, current medications, and lifestyle choices, to provide safe and effective dental care.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign health history

Edit
Edit your health history form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your health history form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit health history online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Here are the steps you need to follow to get started with our professional PDF editor:
1
Log into your account. In case you're new, it's time to start your free trial.
2
Upload a file. Select Add New on your Dashboard and upload a file from your device or import it from the cloud, online, or internal mail. Then click Edit.
3
Edit health history. Add and replace text, insert new objects, rearrange pages, add watermarks and page numbers, and more. Click Done when you are finished editing and go to the Documents tab to merge, split, lock or unlock the file.
4
Get your file. Select the name of your file in the docs list and choose your preferred exporting method. You can download it as a PDF, save it in another format, send it by email, or transfer it to the cloud.
Dealing with documents is simple using pdfFiller.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out health history

Illustration

How to fill out Health History

01
Begin with personal information: Enter your full name, date of birth, and contact details.
02
Fill in medical history: Include any past illnesses, surgeries, and hospitalizations.
03
List current medications: Document any prescription drugs, over-the-counter medications, and supplements you are taking.
04
Provide family medical history: Note any chronic illnesses or genetic conditions in your immediate family.
05
Detail allergies: Include any known allergies to medications, foods, or environmental factors.
06
Note lifestyle factors: Provide information on your diet, exercise habits, and substance use (e.g., tobacco, alcohol).
07
Review and update: Carefully review the information for accuracy before submission.

Who needs Health History?

01
Individuals seeking healthcare services.
02
Patients undergoing medical evaluations or procedures.
03
New patients registering at a healthcare facility.
04
Participants in clinical trials or research studies.
05
Providers assessing the health risks of patients.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
38 Votes

People Also Ask about

A comprehensive health history investigates several areas: Demographic and biological data. Reason for seeking health care. Current and past medical history. Family health history. Functional health and activities of daily living. Review of body systems.
medical history. Listen to pronunciation. (MEH-dih-kul HIH-stuh-ree) A record of information about a person's health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests.
A health record (also known as a medical record) is a written account of a person's health history. It includes medications, treatments, tests, immunizations, and notes from visits to a health care provider.
It includes the patient's age, gender, most pertinent past medical history and major symptoms(s) and duration. Whenever possible, this statement should identify the significant issue from the patient's perspective, and include the patient's words if the patient accurately represents the reason for the presentation.
Synonyms of health fitness. wellness. healthiness. strength. soundness. wholesomeness. agility. vigor.
A personal health history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise.
An element of a patient's history that aids diagnosis because the patient affirms that it is present.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Health history is a comprehensive record of an individual's past and current health status, including medical conditions, treatments, surgeries, allergies, medications, and family health history.
Individuals seeking medical care, applicants for health insurance, and participants in clinical trials are generally required to file a health history.
To fill out health history, individuals should provide detailed and accurate information about their medical background, including illnesses, surgeries, medications, allergies, family health history, and lifestyle factors.
The purpose of health history is to provide healthcare providers with necessary information to diagnose conditions, plan appropriate treatments, and monitor health outcomes.
Health history should report personal medical history, family health history, medications currently taken, known allergies, surgeries, chronic conditions, and lifestyle factors such as smoking or alcohol use.
Fill out your health history online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.