About this template
An adult physical exam form is an essential tool for physicians, nurses, and healthcare providers to streamline patient intake and document comprehensive health evaluations. This form allows clinical staff to collect vital health metrics, past medical history, current symptoms, medication details, and allergy information before or during a patient visit.
Transitioning from paper charts to digital intake saves valuable time during appointments and ensures patient records are organized and accessible. With Doc2Form, you can instantly turn this structured layout into a fully functioning Google Form, allowing patients to complete their health history conveniently from their smartphones, tablets, or computers.
Whether you operate a private family practice, a specialized clinic, or a wellness center, this template helps standardize your medical documentation process. Easily customize questions, add clinic branding, or adjust sections to match your specific examination protocols and compliance standards.
Key features
- Collect detailed patient medical history and current symptoms digitally
- Record vital signs, weight, height, and general health metrics
- Streamline pre-visit patient onboarding and reduce waiting room clipboards
- Access responses instantly in Google Sheets for effortless record-keeping
- Fully customizable layout to fit your clinic's specific examination guidelines
Use cases
- Annual wellness exams and routine physical checkups
- Pre-employment medical clearances and sports physicals
- New patient onboarding for primary care clinics and family practices
- Telehealth pre-consultation health history assessments
What this form collects
- Full Legal Name (Short answer)Enter your first, middle, and last name.
- Date of Birth (Date)Enter your date of birth.
- Biological Sex (Multiple choice)Select your sex assigned at birth.
- Primary Phone Number (Short answer)Enter the best phone number to reach you.
- Current Medical Conditions (Checkboxes)Select all conditions that you have currently or have been treated for in the past.
- Current Medications (Paragraph)List all prescription medications, over-the-counter drugs, and supplements you currently take regularly.
- Known Allergies (Paragraph)List any allergies to medications, foods, latex, or environmental triggers, along with your typical reaction.
- Recent Symptoms (Checkboxes)Select any symptoms you have experienced over the past 30 days.
- Describe Any Current Health Concerns (Paragraph)Provide details on any specific issues or pain you would like the doctor to address during your exam.
- Height (Short answer)Enter patient height (e.g., 5 ft 10 in or 178 cm).
- Weight (Short answer)Enter patient weight in pounds or kilograms.
- Blood Pressure (Short answer)Record systolic and diastolic blood pressure (e.g., 120/80).
- Heart Rate (Pulse) (Short answer)Record resting heart rate in beats per minute.
- General Physical Assessment Notes (Paragraph)Enter findings from head-to-toe examination (HEENT, cardiovascular, respiratory, musculoskeletal, etc.).
- Clinician Recommendations & Plan (Paragraph)Detail follow-up instructions, lifestyle recommendations, or referrals.
FAQ
How do I use this adult physical exam template with Doc2Form?
Simply use Doc2Form to instantly convert this template into a ready-to-use Google Form in seconds. No complex setup or coding required.
Can I add or remove questions from this physical exam template?
Yes! Once the form is generated in your Google Drive, you have full control to edit, add, or delete any questions using the standard Google Forms editor.
Where are patient responses stored?
All submissions are saved securely in your Google Workspace account and automatically populated into a linked Google Sheet for easy review.
Is this template suitable for telehealth appointments?
Absolutely. You can send the Google Form link to patients via email or text prior to their virtual visit so you can review their health history in advance.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.