NEW PATIENT HISTORY - UC Health 2026

1. Click ‘Get Form’ to open the NEW PATIENT HISTORY - UC Health in the editor.
2. Begin by filling out the IDENTIFYING INFORMATION section. Enter your name, date of birth, and age. Include your significant other's details if applicable, and select your primary language.
3. In the PREGNANCY HISTORY section, provide details about all pregnancies, including full-term births and miscarriages. Use the provided fields to document each pregnancy's specifics.
4. Complete the CONTRACEPTIVE USE section by listing types of contraception used, duration, and reasons for discontinuation.
5. Proceed to SURGERIES AND HOSPITALIZATIONS. Fill in dates and reasons for any surgeries you have had.
6. In the MEDICAL HISTORY section, check any conditions you have or have had. Be thorough in documenting any additional medical problems not listed.
7. Continue through ALLERGIES, MENSTRUAL/HORMONAL history, GYNECOLOGIC/INFECTION history, and SEXUAL HISTORY sections as prompted.
8. Finally, review FAMILY HISTORY/GENETIC HISTORY and HISTORY OF FERTILITY THERAPY sections carefully before submitting your form.

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