Family History Form...suggestions?

[camay1221_RN]

I work in a clinic for a pediatrician, and we do all computer charting. The thing is, with new pts and with newborns, it would take too long to go through the family medical history on the first visit, so the MD and I want to come up with a form we can give to the parents that they can complete while they wait for the MD to come into the room, or take home and send back. Does anyone have an example of such a form? It doesn't necessarily have to be pediatric, as we will probably make up one of our own, but I would like some ideas.

Any and all help would be appreciated.