Pediatric Health History Questionnaire

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What’s up doc? Here’s something that’ll make your job a little easier

Providing a medical professional with the health history of your child can sometimes be an overwhelming task. Help your patients’ parents by asking only the relevant questions, one at a time. This template shows how you can do things differently.

Pediatric health history questionnaire FAQs:

1. How can I simplify the process of getting my pediatric patients’ health history?

Health history forms tend to present people with all possible questions regarding their health, even if they’re not relevant to them. The result? Confused parents and patients, and clogged up data for you as a doctor.

But no more! By remembering previous answers, this pediatric health history questionnaire easily guides parents through the process. So you get the answers you need to create an effective treatment plan.

2. How can I implement this pediatric health history questionnaire in my practice?

With no need for coding or design skills, simply start with this template and make edits to your form, adding or removing questions based on your needs. You’ll soon see how easy it is. Add a pop of color and your own branding, or choose from one of our ready-made design themes.

You can send out this form in an email as part of your intake process. This will help you to come to your appointments with all the info you need, helping parents feel at ease knowing their little ones are in safe hands.

3. What should I consider before using this healthcare form?

Before you send out your form, there are two things you should do:

  1. Set up a BAA (Business Associate Agreement) with us

Typeform is a HIPAA-compliant company, so all the healthcare-related info you process with us is legally airtight. But for you to be 100% HIPAA compliant, you’ll first need to set up a BAA. Do this by filling out this typeform, or contacting your Typeform account manager.

  1. Check the local data collection laws

Data collection laws aren’t a one-size-fits-all thing—especially when there’s sensitive medical info involved. So before hitting share, seek advice from a local lawyer to make sure you’ve covered everything.

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Here's what people say about us

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro

Form builders are as old as the web, but Typeform elevates the medium substantially.

Johnny Rodgers

Product Architect

Slack

We’ve received 3x the responses using Typeform than from a professionally commissioned market research study

Kate Donhoe

Head of Product Marketing

Pitch

Leads from the Typeform integration were twice as likely to convert.

Tobias Wasmer

Marketing Manager @ Volvo Cars

Volvo

You used to need developers to do all this. Not anymore.

Kyle Maltz

Chief Operating Officer

Dollar Flight Club

Typeform is a production-grade system for our entire growth funnel.

Gaurav Vohra

Head of Growth

Superhuman

Typeform helps me attract more responses and a higher response rate than other tools.

Rand Fishkin

CEO + Founder

SparkToro
Collect 18% more data with Typeform compared with our two main competitors in the market

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