About this template
Gathering accurate health histories is critical for any medical or wellness practice, but chasing down paper forms slows down patient care. This Client Medical History Google Form template simplifies intake by collecting essential background data directly into Google Drive. Designed for doctors, physical therapists, wellness coaches, and clinical staff, it covers everything from vital statistics and past medical conditions to family health history, current medications, lifestyle habits, and nutritional routines.
Using Doc2Form, you can instantly turn this structured medical intake template into a live Google Form. Patients can complete it securely from any device before their visit, ensuring your team has all the necessary clinical context ahead of time. All responses organize automatically into Google Sheets for easy review, secure record-keeping, and integration with your existing practice workflows. Spend less time tracking down paperwork and more time focusing on patient care.
Key features
- Collect complete patient health and medical history securely.
- Track current medications, supplements, and past injuries in one place.
- Capture lifestyle factors including exercise frequency, nutrition, and habits.
- Built-in Google Sheets syncing for seamless patient record management.
- Fully customizable sections to fit your specific clinical or wellness practice.
Use cases
New patient onboarding at private medical and chiropractic practices.
Initial health assessments for personal trainers and wellness coaches.
Pre-appointment screening for physical therapy and rehabilitation cli…
Pre-appointment screening for physical therapy and rehabilitation clinics.
Comprehensive intake for specialized holistic health and nutrition pr…
Comprehensive intake for specialized holistic health and nutrition programs.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Phone Number (Short answer)Provide a reliable phone number where we can reach you.
- Email Address (Short answer)Where should we send appointment confirmations and follow-ups?
- Gender (Dropdown)Select your gender identity.
- Birth Date (Date)Enter your date of birth (MM/DD/YYYY).
- Height and Weight (Short answer)Please enter your height in inches and weight in pounds.
- Medical Condition History (Paragraph)List any past or current medical conditions (e.g., hypertension, diabetes, asthma).
- Family Medical History (Paragraph)Note any significant health conditions that run in your immediate family.
- Past Injuries and Surgeries (Paragraph)Describe any major injuries or surgeries along with approximate dates.
- Current Medications and Supplements (Paragraph)List all prescription medications, over-the-counter drugs, and supplements you currently take.
- Exercise Frequency (Multiple choice)How often do you engage in physical exercise?
- Cardio Exercise Status (Paragraph)Describe your current weekly cardio routine and approximate minutes per session.
- Strength Training Routine (Multiple choice)Do you currently participate in strength training or resistance exercises?
- Eating Habits & Nutrition (Paragraph)Describe your typical daily nutrition, dietary restrictions, or any specific nutritional plans you follow.
- Substance Consumption (Paragraph)Please indicate your typical consumption levels.
- Smoking Status (Multiple choice)Do you smoke or use tobacco products?
- Additional Medical Concerns (Paragraph)Please share any other details or health goals you would like your practitioner to know.
FAQ
How do I use this medical history template with Google Forms?
With Doc2Form, you can instantly generate this exact form inside your Google account. Just preview the template, click to convert, and it will be created directly in your Google Drive as an editable Google Form.
Can I customize the questions for my specific practice?
Yes! Once the template is in your Google Forms account, you have full control. You can add, delete, or rearrange questions to match your exact clinical or wellness requirements.
Where do patient responses get saved?
All submissions go directly to a Google Sheet linked to your form, allowing your team to review, sort, and reference client details securely.
Is this template free to use?
Yes, this template is completely free to convert and deploy using Doc2Form and Google Forms.
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.