Medium

Available on

Apple Android Windows

Non-Football Health History Form Mobile App

This mobile application takes the place of a health history paper form. It includes patients basic information like name, birth date, address, age, social security number and more. Then it goes into depth about past health problems and injuries.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Non-Football Health History Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Sport

  • Ico textbox

    Full Name

  • Ico date

    Birth Date

  • Ico multiline

    Address

  • Ico textbox

    Age

  • Ico textbox

    Last School Attended

  • Ico textbox

    A.

  • Ico textbox

    B.

  • Ico textbox

    C.

  • Ico textbox

    D.

  • Ico statictext

    E.

  • Ico textbox

    1. HEART TROUBLE

  • Ico textbox

    2. ASTHMA

  • Ico textbox

    3. BACK TROUBLE

  • Ico textbox

    4. DIABETES

  • Ico textbox

    5. CONVULSIONS

  • Ico textbox

    7. PNEUMONIA

  • Ico textbox

    8. SINUSITIS

  • Ico textbox

    9. HEPATITIS/JAUNDICE

  • Ico textbox

    10. HIVES

  • Ico textbox

    11. MONONUCLEOSIS

  • Ico textbox

    12. MIGRAINE

  • Ico textbox

    13. KIDNEY TROUBLE

  • Ico textbox

    15. RHEUMATIC FEVER

  • Ico textbox

    16. PILONIDAL CYST

  • Ico statictext

    F.

  • Ico statictext

    1. Sprain or strain of:

  • Ico textbox

    a.

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Football Health History Form

This mobile application takes place of a football health form. It asks for the patients basic information name, address, b...

App Name

Occupational Therapy School Evaluation

The Occupational Therapy School Evaluation mobile app, while primarily targeted towards students in occupational therapy s...

App Name

Pre-Participation Physical Exam

This mobile application is a medical history exam to be filled out before a sport. It asks for the students basic informat...

App Name

Sports Medicine Department

This mobile application is for the athletic trainer to fill out. It has a checklist of professional dimensions and their ...

App Name

Student-Athlete Referral & Consultati...

This mobile app is to refer a student to a doctor of some kind. It asks for the students basic info name, SS#, sport, DOB,...

App Name

Student Athlete Daily Treatment Form

This mobile app is for an athlete and athletic trainer. It includes things like name, port, injury, exercise, bike, ice ma...

App Name

Medical Patient History

The Medical Patient History mobile app allows health care providers and health professions to collect a detailed family hi...

App Name

Medical History

Designed for healthcare professionals working with the elderly patients, this application allows the clinicians to note th...

More Information