Medium

Available on

Apple Android Windows

Medical History Form Mobile App

The Medical History Form mobile app provides copies of medical records for all kinds of professionals in the health care industry. The app is compatible with smartphones, mobile devices, and PCs, meaning comprehensive electronic medical records can be easily accessed in the palm of your hand. No matter what kind of medical treatment you offer, if you are a health care provider then you need complete, up-to-date health history for the client or patient you are helping. Next time you offer a medical examination, make sure you have all the facts. The Medical History Form mobile app makes it easy for you and the client to receive the best health care possible.

The Medical History Form mobile app lets you track and access many areas of health history, including previous healthcare providers, previous medical care, family medical history, and other vital records. Don't risk a medical malpractice lawsuit because you didn't have the right medical reports or the most recent electronic health records. Whether you are primary care physician, a mental health specialist, or a wellness center professional, this app will help all kinds of medical providers deliver the highest quality medical care they can.

Come check out all of our best-selling general health forms and apps!

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

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Medical 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 dropdown

    Are you under a physician's care now?

  • Ico multiline

    If yes, please explain

  • Ico dropdown

    Have you ever been hospitalized or had a major operation?

  • Ico multiline

    If yes, please explain.

  • Ico dropdown

    Have you ever had a serious head or neck injury?

  • Ico multiline

    If yes, please explain

  • Ico dropdown

    Are you taking any medications, pills or drugs?

  • Ico multiline

    If yes, please explain

  • Ico dropdown

    Do you take, or have you taken, Phen-Fen or Redux?

  • Ico multiline

    Please explain

  • Ico dropdown

    Are you on a special diet?

  • Ico multiline

    Please explain

  • Ico dropdown

    Do you use tobacco?

  • Ico dropdown

    Do you used controlled substances?

  • Ico dropdown

    Are you pregnant/trying to get pregnant?

  • Ico dropdown

    Are you taking oral contraceptives?

  • Ico dropdown

    Are you nursing?

  • Ico statictext

    Check the following if you are allergic to any listed.

  • Ico checkbox

    Aspirin

  • Ico checkbox

    Penicillin

  • Ico checkbox

    Codeine

  • Ico checkbox

    Acrylic

  • Ico checkbox

    Metal

  • Ico checkbox

    Latex

  • Ico checkbox

    Local Anesthetics

  • Ico textbox

    Other

  • Ico multiline

    If yes, please explain

  • Ico statictext

    Do you have, or have you had, any of the following?

  • ...and More!

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

App Name

Rehabilitation Patient Care History Form

The Rehabilitation Patient Care History Form Mobile App helps record and track patient history related to rehabilitation s...

App Name

Camps/Clinics Emergency Health Inform...

This mobile application states the health information needed for an athlete. It also has an area for a physician to approv...

App Name

Health Care Financial Agreement Form

Patients are responsible for covering all costs of services rendered that are not covered by their health care insurance. ...

App Name

Chest Pain Evaluation: Aortic Dissection

The Chest Pain Evaluation: Aortic Dissection mobile app is intended to be used by cardiologists and emergency room physici...

App Name

COSHH: Schedule 1 Other Substances an...

The COSHH: Schedule 1 Other Substances and Processes to Which the Definition of “Carcinogen” Relates mobile app contains t...

App Name

Building Sanitation Procedure: Correc...

The purpose of monitoring is to find any unacceptable conditions or practices as soon as possible and before they can have...

App Name

Workplace Inspection Form

The Workplace Inspection Form mobile app offers a simple way to compete health and safety assessments from anywhere in the...

App Name

Epidemiology Surveillance Laboratory ...

This epidemiology surveillance laboratory record for the Department of Health of New Jersey has been turned into an easy t...

More Information