Health History Forms

 

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Surgeon General's Family Health History Tool

The U.S. Department of Health and Human Services has released an updated and improved version of the Surgeon General's internet-based family health history tool. The new tool makes it easier for patients to assemble and share family health history and can also help practitioners make better use of health history information. For more detailed information about the new tool, please visit the website listed.

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Brief Sex History Questionnaire

This questionnaire may be used as part of the review of systems with patients. The clinician might begin, "I need to ask a few short questions about your sexual health in order to be thorough in providing your medical care."
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Adult Medical History Form2-SPANISH

A Spanish translation of the Adult Medical History Form.
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Adult Medical History Form1-SPANISH

A Spanish version of the Adult Medical History Form.
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Oral Contraceptive Interval History Form

A sample oral contraceptive interval history form in English and Spanish.
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Social History Form-SPANISH

A Spanish translation of the 1-page sample social history form.

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Depo-Provera Interval History Form

A sample Depo-Provera interval history form in English and Spanish.
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Adult Health History Questionnaire

Adult health history qustionnaire with a number of social and behavior related questions.
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