Social History

Tobacco
Years old
/
Ago
Alcohol
/
Ago
Sexual
Ago
Regular sexual partner
Irregular sexual partner
Male
Female
Substance abuse
Domestic violence
Physical activity
/
Animals contact
Animals product ingestion
Diet
Type
Minerals
Vitamins
Dietary restrictions
Exposure to
Occupation
Hobbies
Activities
Forensic history
Housing
Who they live with?
Home Help
Any support services?
City environment
Income