3 minutes
There is no specific eligibility criteria for filling out a General Medical History Form.
Name
Age
Contact number
Contact Email
Address
State / Province
Country
Do you have any allergies
Mention the allergy
Do you follow any specific medication
Mention the medication type
Name of the dose
Times per day
Mention the vaccines you had in past 6 Months
Select the medical complication you have or you had in past 6 months
Any significant family history is known
Relation to patient
Mention the last specific visit