www.FREE-FAMILY-MEDICAL-HISTORY-FORM - NTM Info

www.FREE-FAMILY-MEDICAL-HISTORY-FORM.com - Free Family Medical Health History Form - Complete all the fields as best you can. The form does not have to be complete but every piece of information helps. Include at least 3 generations of family members, if possible, to provide your doctors the most complete picture of your family’s medical history.

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www.dshs.state.tx.us

Current medical information is defined in our rules as being less than 12 months old. An examination will be necessary if one has not been conducted within 12 months. Please complete and return the MAB Medical History Form to the MAB by the following: Mail: Texas Department of State Health Services ATTN: Medical Advisory Board (MC 1876) PO

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