Patient Medical History Form
Allergies and current medications, before the appointment.
- Free to use and customise
- No code — everything is drag and drop
- Embed anywhere — one snippet, any website
What this template uses
- Stores leads and can notify you by email
- Connects to CRMs and supports webhooks
This is the real template — step through it, but submissions are switched off here.
About this template
The two things a clinician needs in front of them at the start of an appointment rather than half way through it. Allergies default to None so the field is answered either way.
Good for
- New patient intake.
- Pre-appointment questionnaires.
- Specialist referrals.
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Make it yours
Change any field, formula or colour. Then embed it on your website.
Start free with this template ↗