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Orthopedic Surgery & Sports Medicine Patient History Questionnaire 2025

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The document is a Patient History Questionnaire for Orthopedic Surgery and Sports Medicine, designed to collect comprehensive information about a patient's medical history, current symptoms, medications, allergies, surgical history, family history, social habits, and review of systems. It aims to assist healthcare providers in understanding the patient's condition and tailoring appropriate treatment.

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Click ‘Get Form’ to open the Orthopedic Surgery & Sports Medicine Patient History Questionnaire in our editor.
Begin by entering your personal information at the top of the form, including your name, date of birth, and age. Select your gender by checking the appropriate box.
In the 'History of Your Problem' section, provide details about your current issue. Include the date of injury if applicable and describe your symptoms along with any previous tests or treatments.
Rate your pain intensity on a scale from 0 to 10 in the designated field.
Move to 'Your Medical History' and check all relevant medical conditions you have been treated for. If necessary, list additional conditions in the provided space.
List all medications you take regularly in the medications section, ensuring to include dosages and frequency.
Indicate any allergies you have and describe your reactions in the allergies section.
Complete the surgical history by listing all past surgeries along with any complications experienced post-surgery.
Fill out family history by marking conditions that affect family members and providing their relation to you.
Answer social history questions regarding marital status, employment, alcohol consumption, and smoking habits.
Review systems for any current symptoms by circling applicable issues under each system category.
Finally, sign and date the form at the bottom before submitting it through our platform for processing.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the history of orthopedic surgery?

Orthopedic surgery has a long and rich history. While the modern term orthopedics was coined in the 1700s, orthopedic principles were beginning to be developed and used during primitive times. The Egyptians continued these practices, and described ways to recognize and manage common orthopedic conditions.

What is the history of surgery?

Robert Jones was born on 28 June 1857, in Rhyle, Wales. Through his interest and work in the field, Robert Jones helped establish orthopaedics as a surgical specialty.

Who is the father of orthopedic surgery?

Orthopaedic surgery as a medical specialty began in the United States with John Ball Brown [19].

What questions are asked for medical history?

The Rest of the History Past Medical History: Start by asking the patient if they have any medical problems. Past Surgical History: Were they ever operated on, even as a child? Medications: Do they take any prescription medicines? Allergies/Reactions: Have they experienced any adverse reactions to medications?

What are good patient history questions?

Questions about past illnesses What illnesses or diseases have you had in the past? Since your initial diagnosis and treatment, have your illnesses returned? How has the illness impacted your daily life and activities? What medical care did you get for the illness? When did you first notice the diseases symptoms?

most common orthopedic procedures

department of orthopedic surgery uf health orthopedic surgery www ortho ufl edu jrep medical records fax number new patient medical history form orthopedic surgeon gainesville, fl unf medical records uh health medical records

What to expect after orthopedic surgery?

Some soreness after surgery is expected but should gradually get better week by week. Patients often comment that they no longer feel the grinding, deep joint pain with weight bearing that they had prior to surgery, and that most of the discomfort after surgery is muscular pain in the area of the incision.