What is a Health History Form?

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  • Written By: Felicia Dye
  • Edited By: Heather Bailey
  • Last Modified Date: 22 November 2019
  • Copyright Protected:
    Conjecture Corporation
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A health history form is usually an important part of a patient’s medical file. Such a form acts as a questionnaire to obtain information about the health history of an individual. The form also gathers information about the patient’s family.

When a person seeks treatment, it is common for her to be asked to complete a health history form. This is likely to be the case whether she is seeing an optician, a gynecologist, or a psychiatrist. Professionals in almost every area of health services recognize how vital the health history form can be when treating a patient.

The health history form usually begins by collecting demographic information. This includes things such as the patient’s name, age, and ethnicity. This information is important because it helps prevent one patient’s details from being confused with another’s. It is also important, however, because these details may have an impact on the diagnosis.

There is generally a list of common conditions. The patient is requested to disclose whether she has ever been affected by them. If she answers “yes” to any particular condition, she is normally requested to provide the dates and the details. In some instances, she may need to include details of how the condition was treated. This section normally also contains space for the patient to discuss any conditions she has suffered from which are not listed.


In addition to providing this information about herself, the patient is also generally asked whether any family members have suffered from the listed conditions. If she answers “yes” then she will usually be asked to specify which member of the family had the problem. She may also be asked to provide any further details that she has in that regard. This information can be very important when assessing whether certain ailments stem from genetic problems.

A health history form normally has an area that pertains to procedures the patient has undergone. This is where she will disclose whether she has ever had surgery. If a person has undergone any serious procedures, such as open heart surgery or chemotherapy, she will normally need to provide the dates of when that treatment began and ended.

It is also important for a health professional to know what allergies the patient has. There is usually a section for her to disclose if she is allergic to any medications. She may also reveal allergies to other things such as nuts or latex. Allergic reactions may also be revealed by the information that is provided regarding medications that the patient is currently taking. One of these, or a mixture, could be the cause of her ailments.



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