New Patient Adult Medical/Dental Health History Form

Form Template

The New Patient Adult Medical and Dental Health History mobile app is a complete medical data tracking form that is simple for any person to fill out.

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This is a great app for any dentist's office, health care professional, or public health center. You also have peace of mind knowing all medical records are securely saved in the GoCanvas Cloud.

This patient registration form allows the patient to enter all medical records, such as dental care history, insurance information, previous injuries, previous medical and dental treatments, previous medications, and even previous doctors. From questions posed about levels of comfort down to the specifics of the last check-up date, this app includes all the upfront screening and history.

This app is available on an iPhone, iPad, or Android device. You also have option to print or email health records as a PDF if you need to share them with another dental practice, health care provider, or keep for your records.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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