Child Patient History Form Template

Gather necessary child medical history from parents and guardians with our free form template.

Physicians and medical professionals can gather vital medical history about their young patients right on their mobile devices during the patient visit. Perform follow up questions and record medical conditions that can help you make the right health choices for patients.

Try our child patient history form template for free on any mobile device with a free trial of IntouchCheck mobile form software. Sign up for a free trial today and ask your Intouch specialist to load this pre-built form into your account.

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Obtaining the family medical history from children can ensure that they receive the quality health care that is required during their visit with the physician. Yet information can get left out that may cause a range of present or future medical issues. The child medical history form allows you to ask all the pertinent questions from parents and guardians of young children to find out the child's family medical history, present medications they are taking and other health questions.

Form Details

This new patient medical history form allows you to gather child medical information when patients come in for wellness checkups and health issues. The free template provides easy-to-follow categories so you can include all the basic medical history information that you want to gather while performing the medical interview in the office. The child patient history form template can be used on desktops and all mobile devices including iPhone, iPads, smartphones and tablets.

You can gather the child's medical history quickly and thoroughly so you can update medical records and provide the best health care possible. The mobile form can also be copied and emailed to other medical professionals for referral purposes.

The new patient medical history form includes the following sections:

  • Child information
  • Pregnancy information
  • Birth details
  • Maternal complications/issues
  • Child's medical history
  • Family medical history
  • Physician signature

Customize Your Digital Child Patient History Form Template

We know that every business is unique, and your forms should reflect that. Our ready-to-use template is a comprehensive list of industry standard fields, but it is most useful when customized to reflect your own needs. The IntouchCheck platform makes it simple to quickly customize the mobile form template to meet the individual needs of your company and goals; questions, fields, or sections can be quickly removed, and new queries or fields can be added in the appropriate places to fit your project.

Create Your Own Child Patient History Form Template

Already have processes and procedures in place? IntouchCheck’s straightforward interface makes it fast and easy to create your own forms, where you can customize the sections, categories, questions, and types of data/image capture fields. We’re here to help you get started! Try IntouchCheck for free, and see how easy it is to streamline your business processes.