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Medical History Form
Free medical history form template for a new patient, camp, or program requiring health background.
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- No signup required
- Free, always
This free medical history form covers Medical Information, Physician, Insurance, Additional Notes, Consent with 8 clearly marked [placeholder] fields to fill in — built for small business owners and first-time managers handling an HR moment professionally without a dedicated HR department to lean on. Copy it into your own word processor, fill in the placeholders, and review it — or adapt it — before use. It's part of docstoc's free document template library, alongside business, legal, real estate, finance, and HR templates. Every template here is free to copy with no signup required, and each one carries a plain disclaimer: this is a starting point for informational purposes, not a substitute for advice from a licensed professional in your jurisdiction.
Medical History Form
Name: [Name] · Date of Birth: [Date] Emergency Contact: [Name, Phone, Relationship]
Medical Information
Known allergies: [List, or "None"] Current medications: [List, or "None"] Chronic conditions: [List, or "None"] Past surgeries/hospitalizations: [List, or "None"]
Physician
Name: [Name] · Phone: [Phone]
Insurance
Provider: [Name] · Policy #: [Number]
Additional Notes
[Anything else relevant — dietary restrictions, mobility considerations, etc.]
Consent
I certify the above information is accurate and authorize its use for the purpose of [providing care / participating in program].
Signature: ______________________ Date: ____________ [If minor] Parent/Guardian: ______________________
*Medical history forms often contain protected health information — store and share them securely, and only with people who genuinely need access (e.g. on-site staff during an emergency).*
Edit directly in the box above. Download PDF anytime — the docstoc.io footer is always included and cannot be removed.
What's included
- Edit online — click the document, fill in placeholders, download a PDF
- 5 standard sections: Medical Information, Physician, Insurance, Additional Notes, Consent
- 8 clearly marked [placeholder] fields for quick personalizing
- Free to use — no account or signup required
- Fully editable — adjust any clause to match your actual situation
- Includes a signature block, ready to print or sign digitally
- Fixed docstoc.io footer on every PDF (not removable)
Who this template is for
Freelancers & solo founders
Handling routine business paperwork without commissioning custom legal drafting for every document.
Small businesses
Standardizing recurring documents — leases, agreements, notices — across a growing operation.
Anyone reviewing before signing
Using a clear starting structure to understand what a document should cover, even if a lawyer finalizes it.
Growing teams
Formalizing hiring and performance processes as a company adds its first employees.
FAQ
Is this medical history form template really free?
Yes. Like every template in docstoc's library, this medical history form is free to use, with no account or signup needed to view, edit, or download it.
What does this medical history form cover?
This hr template includes Medical Information, Physician, Insurance, Additional Notes. Fill in the [bracketed] placeholders, edit any clause online, then download a PDF — the docstoc.io footer stays on every export.
Is this legal advice?
No. Employment documents sit on top of a mix of federal, state, and sometimes city labor law — at-will employment rules, required notices, and what you can and can't put in writing all vary. Have an employment attorney or HR professional confirm this fits your jurisdiction before you use it.
Can I edit the wording?
Yes — edit directly on the page, adjust any section or clause, and re-fill the 8 placeholder fields to match your situation before downloading a PDF. It's a starting structure, not a rigid script.
Where can I find more free templates like this?
Browse more free hr and related document templates in the docstoc library at /document-templates/.
More free document templates
- Employee Offer Letter
- Employee Written Warning / Disciplinary Notice
- Employment Agreement
- Cover Letter
- Employee Handbook Outline
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Why use this instead of a generic template
Security
Served over SSL from Cloudflare's edge network — no ad trackers, no third-party scripts on template pages.
Legality
Templates are drafted for general use, not a substitute for legal advice — check the note on each page for specifics.
Privacy
No account or signup needed to copy a template — nothing you type here is stored unless you choose to sign up.
Speed
Copy the subject and body directly — no form to fill in, no export step, no waiting on a download link.
Mobile-friendly
Every template page works the same on a phone as a desktop — copy on the go, no app required.
API available
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