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Medical History Form 2026

A medical history form is a questionnaire used by healthcare providers to collect information about the patient’s medical history during a medical or physical examination. Whether you’re a doctor, nurse, physical therapist, or other medical professional, easily collect your patient’s medical history using this free medical history form. All you need to do is customize the form to match how you want to ask your questions, and then add it to your website. Or share it with a link or embed it! That way, patients can fill out the form at home, or you can print it out and gather responses in person using a tablet or computer.

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This template is ideal for

General Patient Intake

This form is ideal for healthcare providers, including doctors and nurses, to gather essential medical history from new patients. It helps establish a foundational understanding of the patient's health before an initial consultation.

Pre-Examination Screening

Medical professionals can use this form to collect critical health information from patients prior to a physical examination or procedure. This ensures all relevant details are available for a thorough assessment.

Physical Therapy Assessment

Physical therapists can utilize this form to understand a patient's medical background, past injuries, and existing conditions. This insight is crucial for developing a safe and effective rehabilitation plan tailored to individual needs.

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AI builds and refines your form through natural conversation no templates, no complex logic, no coding. From a simple text prompt or URL, Dashform generates intelligent flows that adapt automatically.

Conversations That Understand Context

Dashform turns traditional form-filling into a two-way dialogue. The AI understands intent, remembers context, and asks relevant follow-up questions just like a real human conversation.

Better Data, Better Decisions

Every response is transformed into structured, meaningful, and ready-to-use data. Integrate with your favorite tools.

Powerful features included

Everything you need to create amazing forms

Smart Field Detection
Automatically detects and suggests the best field types for your data.
Real-time Validation
Validate responses as users type with instant feedback and error messages.
Multi-device Support
Forms work seamlessly across desktop, tablet, and mobile devices.
Advanced Analytics
Track form performance with detailed analytics and response insights.

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Welcome to the Medical History Form

Please complete this form to provide your essential medical history. This information helps healthcare providers understand your health background for an accurate assessment.

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