Health Information Sheet

The health information sheet is a quick reference sheet. Like your Medication Sheet and your Supplement/Over-the-Counter Medication Sheet, this information sheet can save your life. In the event you are not able to speak for yourself, family members or rescue personnel will have important information regarding your physicians and medical history (including allergies) at their finger tips.

Your Health Information Sheet should be the first page of your Medical Information Binder and should be placed in a central location in your home. It would be a good idea to carry a copy with you in your purse or wallet. Be sure to tell your friends/family members about this form and where you have it located in your home.

The "miscellaneous" section can be used to jot down your medications or information regarding your advanced directives. You may wish to provide the name and contact information for the persons whom you have selected to be your health care proxy.

Please note, you must have Adobe® Reader® on your computer to view and print this form. If you do not have this software, and would like a free copy of it, please click

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