Medical History Form Template
A free medical history form for trainers, studios and wellness services. New clients share conditions, medications and allergies before their first visit.
Use templateAbout this template
A client intake and medical history form in one. Collect conditions, medications, allergies, past surgeries, and lifestyle details before the first session, then confirm them with a signature.
Common uses
- Personal training and fitness studios
- Massage, spa, and wellness services
- Camps, sports clubs, and activity programs
Key features
- Conditions, medications, and allergies
- Signed by the client
- Ready before the first visit
What this template asks
What's your full name?
Short Text
What's your date of birth?
Date
What's your email address?
Email
What's your phone number?
Phone
Do you have any of these conditions?
Multiple Choice · Optional · Asthma, Diabetes, Heart condition, High blood pressure, None of these
What medications or supplements do you take?
Long Text · Optional
Do you have any allergies?
Long Text · Optional
Have you had any surgeries or hospital stays?
Long Text · Optional
Do you smoke or vape?
Single Choice · Never, In the past, Yes
Is there anything else we should know about your health?
Long Text · Optional
Sign to confirm your answers are accurate
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
What does the Medical History Form collect?
Contact details, date of birth, common conditions, medications and supplements, allergies, past surgeries, smoking, and any other health notes, confirmed with the client's signature.
Who is this medical history form for?
Trainers, studios, wellness services, camps, and activity programs that need health details before a first session. Reuily is not a HIPAA compliant service, so healthcare providers covered by HIPAA should not use it for patient records.
Can clients fill it in before their first visit?
Yes. Send the link with the booking confirmation so you can review their answers before they arrive.