Client Medical History Questionnaire

This simple Medical History Form provides an assessment tool for holistic nutrition practitioners to accurately evaluate each client’s state of health.

The client medical history questionnaire includes questions regarding general health, medications, supplement/herbal remedy information, previous illnesses, family medical history and other pertinent information in this area.

By having your client fill out this form, it will allow you to make safe and relevant recommendations. More importantly, it will help you detect potential emerging conditions before they become pathological.

This is one of the key tools needed by all nutrition practitioners to ensure they are receiving the most in-depth information they can.

premium badge 250

Start your 15-day Premium trial for FREE and access all our advanced forms, assessments and branding options.

Sign Up Now

"I've recently just begun using your consulting forms in my practice. I have to say THANK YOU! Your website has made things a lot easier for myself and my clients. Looking forward to see what you guys come up with next!"

-Janette Mason, Certified Holistic Nutritionist

Medical History Form Preview

Medical History Form Preview 1

Branded, personalize, and easy-to-fill online

Medical History Form Preview 2

dynamic form - only display relevant questions 

Medical History Form Preview 3

Clean instructions for your client to follow

Sample PDF Results: Click here to download the sample PDF results. These results will be accessible through your Hub Premium Membership.

Compare Membership Features

Hub Pro Version

Send to clients via the Form Sender

 Professional look and easy to fill out online

 Formatted results to your email inbox

Brand form with company banner/logo

 Receive results in PDF format to download and save

Sign Up Now

Hub Premium Version

Send to clients via the Form Sender

 Professional look and easy to fill out online

 Formatted results to your email inbox

Brand form with company banner/logo

 Receive results in PDF format to download and save

Sign Up Now

Other Awesome Features

Client Intake Form

The only online intake form you'll ever need. Send it to your client in seconds to assess their current health concerns, goals, stress levels, nutritional habits and more. Learn more...

Nutrient Recommendation Tool

This consulting tool will blow your mind. Pick what micronutrient you want to target, and get suggestions for ideal foods, supportive interactions, and depleting foods. Learn more...

 Save Results To PDF

Save your client's results to PDF format for easy storage and analysis. Each consulting questionnaire can be saved as a PDF file directly to your computer. 

Upgrade Your Practice

Take on more clients, save time, and deliver results.