Document Template

Automated Medical History Form template for healthcare providers.

Detailed medical history is the foundation of good care — but paper history forms take 20 minutes and arrive illegible. Docuplete's conditional interview shows follow-up questions only when triggered: a patient who denies cardiovascular history skips the next ten questions.

What gets automated

Every field — mapped and filled automatically.

Upload your existing medical history form PDF. Common fields for healthcare providers include:

Patient name, date of birth, genderChief complaint and current symptomsPast medical diagnoses (with conditional follow-ups)Surgical historyCurrent medications and dosagesKnown allergies (with reaction type)Family medical history (conditional)Social history: smoking, alcohol, exercisePatient signature and date
Works with your existing PDF. Docuplete doesn't require a special template format. Upload the form you already use.

How it works

Set up once. Send a link every time.

1

Upload your PDF

Upload the medical history form you already use — any standard PDF. No reformatting or special software needed.

2

Map the fields

Open the PDF in Docuplete's visual mapper. Drag answer boxes onto each field exactly where it appears on the form.

3

Send one link

Generate a unique link for each client. They complete a guided interview on any device — no account required.

4

Receive the completed form

On submission the filled PDF is generated, stored, saved to Google Drive, and synced to HubSpot — automatically.

Why it matters

Stop preparing each medical history form by hand.

No manual data entry

Client answers map directly into the PDF. No re-keying, no copy-pasting, no transcription errors.

E-sign with OTP verification

Clients sign in the same session. Identity verified via email OTP — creating a legally defensible audit trail.

RFC 3161 trusted timestamp

Every signed document receives a trusted timestamp — tamper-proof proof of when it was signed, on every plan.

Google Drive auto-save

Completed PDFs are automatically saved to your Drive folder after every submission.

HubSpot sync

Submission data syncs to HubSpot contacts automatically — find or create the record and attach the completed PDF.

Full audit trail

Every submission records who signed, when, from which device — stored alongside the document.

Send your first medical history form in under 10 minutes.

14-day free trial. No credit card. Works with PDFs you already have.

Start free trial

Starts at $69/mo.

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