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City of Santa Clarita Parks, Recreation, and Community Services Department 2016 Camp Clarity Health History Form PARTICIPANT INFORMATION Last Name Gender (circle one): Male / Female First Name Age*

How to fill out health history form and

How to Fill Out a Health History Form:

1. Start by carefully reading the instructions provided on the form. This will give you a clear understanding of the information required and the format in which it should be provided.
2. Begin with your personal information, such as your name, address, date of birth, and contact details. Make sure to double-check the accuracy of these details before moving forward.
3. The next section will typically ask about your medical history. Be as thorough as possible when answering questions about previous surgeries, illnesses, allergies, and chronic conditions. Include relevant dates and any medications you are currently taking.
4. Provide information about your family medical history. This includes any hereditary diseases or conditions that may run in your family.
5. Next, you may be asked about your lifestyle habits. This can include questions about smoking, alcohol consumption, exercise routines, and diet. Answer truthfully to ensure accurate health assessments.
6. If applicable, you may need to provide details about your reproductive history or any gynecological issues. Include information about pregnancies, childbirth, and menstrual history.
7. In the last section, you may be required to disclose your insurance information, emergency contact details, and any additional concerns or comments you may have.
8. Review your completed form to ensure all sections have been adequately filled out. Sign and date the form as instructed.

Who Needs a Health History Form:

1. Patients visiting a new healthcare provider or clinic are typically required to fill out a health history form. This helps the healthcare professionals to have a comprehensive understanding of the patient's medical background and allows them to provide the best possible care.
2. Individuals planning to undergo surgery or specific medical procedures may need to complete a health history form to assess potential risks and ensure optimal treatment.
3. Health history forms are also necessary for individuals applying for certain insurance policies or participating in clinical research studies, as it helps evaluate eligibility and potential risks involved.

Remember, accurately filling out a health history form is essential for accurate medical assessments and personalized care. It is important to be honest and thorough to ensure your healthcare providers have the necessary information to make informed decisions.

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