Annual Health Check-Up Booking Form Template

Template Instructions

The annual health check-up booking form template simplifies the process of scheduling medical examinations, ensuring clients can easily secure their appointments with healthcare providers. This efficient, user-friendly template gathers crucial details such as personal information, health history, and preferred appointment dates, streamlining the booking procedure. Embrace the convenience of facilitating a seamless scheduling experience for both your staff and clients. Begin optimizing your health check-up bookings with SurveyPluto by clicking "Use This Template" today.


Annual Health Check-Up Booking Form Template

11
Questions
Use This Template

Annual Health Check-Up Booking Form Template

Welcome! Start your journey towards better health with our Annual Health Check-Up. Please fill in the form below for a customized and detailed health evaluation.
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*
1.
Your full name:
*
2.
Date of birth:
*
3.
Gender:
Male
Female
Other
*
4.
Phone Number:
*
5.
Email Address:
*
6.
Do you have any existing medical conditions?
Yes (Please specify)
No
*
7.
Are you currently taking any medication?
Yes (Please specify)
No
*
8.
Have you had any surgeries in the past?
Yes (Please specify)
No
*
9.
Preferred date for your health check-up:
*
10.
Preferred time slot:
Morning (8:00 AM - 12:00 PM)
Afternoon (1:00 PM - 4:00 PM)
No preference
11.
Is there any specific area of health or concern you would like the check-up to focus on?
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