OB/GYN Intake Form

The OB/GYN Intake Form is designed for obstetrics and gynecology practices, women's health clinics, and reproductive medicine offices. It captures the specialized information OB/GYN providers need: menstrual history, pregnancy and obstetric history (gravida/para), contraceptive use, gynecological symptoms, sexual health history, and preventive screening status.

The obstetric history section documents previous pregnancies with outcomes, delivery methods, complications, and gestational ages. For pregnant patients, current pregnancy information is captured including estimated due date, current symptoms, and prenatal care history. The gynecological section covers abnormal Pap smear history, STI screening, and common symptoms like pelvic pain, abnormal bleeding, and urinary concerns.

Preventive care tracking includes mammogram and Pap smear dates, HPV vaccination status, and bone density screening when age-appropriate. This template handles both obstetric and gynecological visits, with conditional logic that shows relevant sections based on the visit type. It is also appropriate for midwifery practices and reproductive endocrinology offices.