for acute and chronic conditions

Please select a topic:

Health Inventory
Client Information Form
Minnesota Client Bill of Rights
Acute Illness or Injury Questions

Health History Questionnaire

Please click HERE to download the form.

Client Information Form

Please click HERE to download the form.

Minnesota Client Bill of Rights

Please click HERE to download the form.

Acute Illness or Injury Questions

1. When did this illness begin or injury happen?

2. Have you had this illness or similar injury before? Describe.

3. What was going on in your life when this illness started or injury happened?

4. Did the symptoms come on slowly or suddenly?

5. Describe all your symptoms as specifically as possible. Describe any discharges.

6. What makes the symptoms better?

7. What makes the symptoms worse?

8. Is there anything odd or unusual about your symptoms?

9. Do you feel unusually chilly or warm with this illness or injury? Describe.

10. How do you feel emotionally with this illness or injury?

11. How is this illness or injury affecting your life?