Health Care Consumer Questionnaire 1.0 Description:

The Health Care Consumer Questionnaire is a comprehensive medical history form designed to be filled out by the health care consumer prior to a visit with a health care provider. Any doctor will find this template to be very appropriate for the evaluation of all new patients or all visits to health care providers.

Information included in the Health Care Consumer Questionnaire
· Allergies
· Medications
· Surgeries
· Past Medical History
· Family Medical History
· Review of systems
· Social History
· Religious and cultural beliefs
· Travel history
· Occupational history
· Carcinogen exposure history
· Behavioral risk factors

Health Care Consumer Questionnaire 1.0 Requirements:

· Adobe Reader

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Health Care Consumer Questionnaire security information

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