A family medical history survey, as the name suggests, intends to know the medical records details of a particular family. It is very important to know the medical history due to a number of factors. The first among those is to chalk out a definite plan for a thorough medical check up to diagnose ailments, if any. Another crucial factor is to get an approximate idea about the budget to be allocated for medical expenses.

Sample Family Medical History Survey:

1. Did your children have the usual vaccinations at the right age?

a. Yes

b. No

2. Did any of the members of your family experience major accident/s in the past?

a. Yes ( Please provide the details)

b. No

3. Did any of the members of your family ever suffer from any minor contagious disease?

a. Yes, some have suffered.( Please provide details)

b. Only one of the members have suffered ( Please Provide Details)

c. None

4. Does your family suffer from any particular allergy?

a. Yes( Please give details)

b. No

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