Get the free Medical History Questionnaire

This form is designed to collect comprehensive medical history from patients, including current medications, previous hospitalizations, allergies, and various health conditions. It complies with the requirements set by The College of Dental Surgeons of BC, ensuring that updated medical history is obtained every two years.

How to fill out medical history questionnaire

How to fill out medical history questionnaire

1. Begin by reading the instructions provided at the top of the questionnaire.
2. Fill in your personal information such as name, date of birth, and contact details.
3. Provide your current medications, including dosage and frequency.
4. List any past surgeries or hospitalizations, along with the dates.
5. Indicate any known allergies to medications, foods, or other substances.
6. Detail any chronic illnesses or ongoing medical conditions.
7. Include your family medical history, noting any hereditary conditions.
8. Answer questions about lifestyle choices such as smoking, alcohol consumption, and exercise routines.
9. Review your answers for accuracy and completeness.
10. Sign and date the questionnaire before submitting it.

Who needs medical history questionnaire?

1. Patients visiting a new healthcare provider.
2. Individuals seeking insurance coverage.
3. Participants in clinical trials or research studies.
4. People undergoing certain medical procedures.
5. New mothers undergoing prenatal or postpartum care.

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What is a medical history questionnaire?

A medical history questionnaire is a form used to collect a patient's medical history, including past illnesses, surgeries, medications, allergies, and other relevant health information.

Who is required to file a medical history questionnaire?

Typically, patients seeking medical treatment, undergoing surgery, or applying for health insurance are required to file a medical history questionnaire.

How to fill out a medical history questionnaire?

To fill out a medical history questionnaire, carefully read each question, provide detailed and accurate information about your health history, and review it for completeness before submitting.

What is the purpose of a medical history questionnaire?

The purpose of a medical history questionnaire is to gather essential health information to help healthcare providers assess a patient's health status, diagnose conditions, and plan appropriate treatments.

What information must be reported on a medical history questionnaire?

Information that must be reported includes past medical conditions, surgeries, medications, allergies, family medical history, and lifestyle habits such as smoking and alcohol use.