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Medical Pre-Registration Form

Medical Pre-Registration Form Keeps Information Handy 

   The Medical Pre-Registration Form allows you to record all your pertinent health information in advance when you have the details at your fingertips. Each time you see a doctor or start using a new over-the-counter medication or herbal remedy, add it to the list.  When you see a doctor, dentist, or another healthcare provider, take the list with you.  They always ask you about any changes in your medical history. When they ask, you’ll have it right there in front of you to show them. You’ll have no problem remembering how to spell the drug’s name or recalling the dose you take. 

Quick Access to Details in an Emergency

     Another helpful use (though I hope you don’t have to use it for this) can be an emergency. During a crisis, the last thing you consider as you collect items for a trip to the Emergency Department is the drugs you’re taking. If you keep a copy of this form with you in your wallet or on your phone, you have it all the time. Also, the phone numbers for your healthcare providers and your insurance information are right here for reference. 

  Healthcare Team Loves It, Too

     I’ve been using a form like this for years, and I kick myself if I leave home without it when I go to the hospital or out for a medical appointment. It really helps, and the nurses love it when I hand one of these over (so do paramedics).


Pre-registration form page 1

Front Page: Patient Identifying information, Insurance, preferred pharmacy, healthcare providers, allergies, primary medical conditions and surgeries

Pre registration form_Page_2

2nd Page: Patient medication list. First list drugs prescribed by doctor, then drugs taken that are over-the-counter, and finally any herbs or supplements you take regularly since they can also interfere with medications. 

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