# 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. 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. Canonical: https://reuily.com/templates/medical-history-form Use this template: https://reuily.com/form/from-template/medical-history-form Collections: Requests & Intake, Professional Services, Operations Last updated: 2026-10-15 ## Questions - Question 1: What's your full name? (Short Text, required) - Question 2: What's your date of birth? (Date, required) - Question 3: What's your email address? (Email, required) - Question 4: What's your phone number? (Phone, required) - Question 5: Do you have any of these conditions? (Multiple Choice, optional). Options: Asthma; Diabetes; Heart condition; High blood pressure; None of these - Question 6: What medications or supplements do you take? (Long Text, optional) - Question 7: Do you have any allergies? (Long Text, optional) - Question 8: Have you had any surgeries or hospital stays? (Long Text, optional) - Question 9: Do you smoke or vape? (Single Choice, required). Options: Never; In the past; Yes - Question 10: Is there anything else we should know about your health? (Long Text, optional) - Question 11: Sign to confirm your answers are accurate (Signature, required) Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy. ## 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 ## 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.