MedicalTemplates

  • Overview

  • Using MedicalTemplates

  • Buy MedicalTemplates

  • Volume Discounts

  • Frequently Asked Questions

  • Return on Investment (ROI)

    • MedicalTemplates

    Free Patient Intake Forms

  • Classic Format

  • Colorful Table Format

  • Gray Multi-Table Format

    • Contact Information

    Please direct any questions regarding Medical Templates, MedSpel, ProfileMD Classic, GenericMedList, or this web site to

    Please direct  questions related to the sale or delivery of MedSpel or a MedicalTemplate after purchase to RegNow, our e-commerce provider.

    Last Modified 3/4/2008

    Free Gray Multi-Table Format Health Care Consumer Questionnaire

    (Free New Patient Questionnaire)

     Subscribe in a reader   


    The FREE gray multi-table Health Care Consumer Questionnaire is a comprehensive medical history form designed to be filled out by the health care consumer prior to a visit with a health care provider.   This MedicalTemplate is appropriate for a new patient evaluation or any visit to a health care provider.

    The Health Care Consumer Questionnaire is a detailed 8-page snapshot of an individual’s current and past medical problems. 

    Information included in the gray multi-table format Health Care Consumer Questionnaire

    • Allergies
    • Medications
    • Surgeries
    • Past Medical History
    • Family Medical History
    • Review of systems
    • Social History
    • Religious and cultural beliefs
    • Travel history
    • Occupational history
    • Carcinogen exposure history
    • Behavioral risk factors

    MedicalTemplates are in the Adobe PDF format, which requires the free Adobe Reader.  With Adobe Reader, these templates can be printed as many times as needed on paper meeting your specifications or the specifications of any clinic, hospital, or other health care facility.