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A professional Family Medicine template for healthcare professionals.
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Chief Complaint
AWVQ Simplified
Form Content
There are 2 questions. Introduction (Show the following message at the beginning): Hello, my name is Emma and I am going to help you complete the questionnaire portion of your Annual Wellness Visit. The information that you provide will be summarized for your physician and is needed to complete the exam. This process will take about 30 minutes to complete. If you must stop, you can come back at a later time to finish. If you want me to repeat a question, just say “repeat”. Are you ready? 1. Please upload any photos or files that you have concerns about so the doctor can view it. 2. Are you sick? End. (Show the following information when questionary complete) Thank you for your time! Your information has been saved. We’ll share this with your healthcare provider. You’re all set! We’ll contact you soon with your appointment details. If you have any questions, call us directly. we will see you at your appointment. 
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How to use this template
This comprehensive new patient template helps establish care by capturing complete medical history, current concerns, and baseline health status. Use this for patients during their initial visit to create a thorough medical record.
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