Health History
Capture a patient's medical history before their visit.
Overview
The Health History template helps clinicians gather a patient's medical background before they arrive. Patients record existing conditions, current medications, allergies and relevant family history, along with lifestyle details such as smoking or alcohol use. Collecting this in advance gives the clinician a fuller picture before the appointment begins, saves valuable consultation time, and helps avoid missing important information that might otherwise come up only in passing.
Build the form to suit your specialty using the NodumForms drag-and-drop builder. Use long text fields for ongoing conditions and current medications, multiple choice or checkbox fields for common allergies, and yes/no questions for quick screening such as whether the patient is pregnant or has had recent surgery. Add short text fields for height and weight, and a file upload for previous test results or letters from other clinicians. Apply your practice branding through the Styles panel so the form looks consistent with your other patient communications and feels reassuring to complete.
Health information is sensitive, so the form is built with care: connections use TLS encryption, IP addresses are stored hashed, and NodumForms never trains on your data. This is a secure intake form rather than a medical records or EHR system, and it is not certified as HIPAA compliant, so check it meets your own regulatory and data-protection obligations before going live. Share the form by link in pre-appointment emails or embed it on your website, review answers in the Individual view, and delete a response once the history is recorded in the patient's notes.
Perfect for
Know the patient's history before the consultation
GPs, physiotherapists and specialist clinics use this form to collect medical history ahead of a first appointment. After booking, the patient receives the link and completes their conditions, medications and allergies at home. The clinician reviews the answers in the Individual view before the consultation, arriving prepared and able to spend the appointment on care rather than form-filling.
Why this template works
- Capture conditions, medications and allergies before the appointment
- Save consultation time by reviewing history in advance
- Protect sensitive data with TLS encryption and hashed IP addresses
- Delete responses once recorded in the patient's notes
How to use
- Choose the Health History template to load the questions into your builder.
- Customise the conditions, screening and allergy fields for your specialty, and add your branding.
- Publish the form and send the link in pre-appointment emails, or embed it on your website.
- Review answers in the Individual view, then delete responses once recorded in the patient's notes.
What this template includes
- Patient name
- Existing medical conditions
- Current medications
- Known allergies
- Relevant family history
- Previous test results upload
- Smoking and alcohol use
FAQ
- Is the Health History form a medical records system?
- No. It is a secure intake form for collecting history before a visit, not an EHR or certified HIPAA system. Submissions use TLS and hashed IPs, but confirm it meets your own regulatory requirements first.
- Can I tailor the questions to my specialty?
- Yes. Use the builder to add long text, checkbox and yes/no questions for the conditions, medications and screening items relevant to your field, and a file upload for previous test results.
- How is sensitive health data protected?
- Submissions are sent over TLS encryption and IP addresses are stored hashed. NodumForms does not train on your data, and you can delete a response once the history is recorded in the patient's notes.