Page 1 of 6 ADULT PERSONAL HEALTH RECORD AND MEDICAL HISTORY Bring this form with you each time you visit your Health Care Professional ALLERGIES: Patient Name_____ . Adult. New Patient. Health History. Questionnaire. Your answers on this form will help your health care provider get an accurate history of your medical concerns and conditions. If you are a current patient there is a shorter update form .
Apr 11, · An adult health history form is used to gather health information precisely for a doctor’s clinic, hospital or office of an adult individual. This form is used by doctors when they want to know the medical history of a patient. This is useful as the doctor will know what they are working with. The doctor can remember the past illnesses of the patient concerned with the aid of this form. GENERAL MEDICAL HISTORY FORM, ADULTS (Continued) Check here if there has been no change on this page since you last completed this form Long-Term Illness/Chronic Medical Concerns Illness Date of Diagnosis Surgery History File Size: KB.