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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
  • Red Bull
  • Mirvac

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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.'}}

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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!

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