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Did You Know?

Maintaining your own personal health record is one of the best ways to have constant access to your health information over the course of your lifetime. Whether you change physicians or your physician relocates or retires, by keeping your own personal health record you and your family will have vital information at your fingertips.

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Free Health Record Forms

Adult Form
English: PDF | Word
Spanish: PDF | Word

This fifteen-page form contains space for recording:

  • Allergies
  • Identification
  • Medical history
  • Major illness/operations
  • Medications
  • Infectious diseases
  • Immunizations
  • Health maintenance
  • Devices and prostheses
  • Eye information
  • Healthcare documents
  • Family medical history

Child Form
English: PDF | Word
Spanish: PDF | Word

This five-page form contains space for recording:

  • Allergies
  • Identification
  • Birth date
  • Growth and development
  • Immunizations
  • Medications
  • Infectious diseases