Patient History Form 2025

1. Click ‘Get Form’ to open the Patient History Form in the editor.
2. Begin by entering your personal information at the top of the form, including your name, birthdate, and the date of completion.
3. In the conditions section, review each listed condition and mark an (X) next to any that apply to you. This helps provide a clear medical history.
4. Next, list any family members who have had specific health conditions in the designated area. This information is crucial for understanding hereditary risks.
5. Fill out the personal habits section by indicating your consumption of caffeinated beverages, alcohol, and tobacco. Be honest about your daily intake.
6. Indicate any allergies you may have, including latex and drug allergies. This ensures safe treatment options.
7. List all current medications along with their dosages in the provided space. Include over-the-counter medications as well.
8. Document any prior surgeries or injuries with dates in the appropriate section to give a comprehensive view of your medical history.

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