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Health History

A standardized, universal health history form that can be completed by the patient before their appointment, and easily updated at subsequent appointments.


This comprehensive template includes all medical and dental history, highlighting health facts and automatically including them in the patient chart. The form also incorporates a smoking cessation component.


View a sample PDF of this template.

Image of template.


Request this template for your ICE Health Systems environment.

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VersionOrigin / ContributorsCreative Commons
1University of MichiganAttribution 4.0 International