OB/GYN Intake Form
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OB/GYN Intake Form
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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.
What's included
- Menstrual and pregnancy history (G/P)
- Contraceptive use and family planning
- Gynecological symptoms and screening history
- Pap smear, mammogram, and HPV tracking
- Medications list with structured medication tracking
- Consent agreement for examination
Who uses this template
- OB/GYN practices and women's health clinics
- Midwifery and birth center practices
- Reproductive endocrinology offices
- Prenatal care providers
All form fields
13 fields across 4 pages. Customize any field after signing up.
How to use the OB/GYN Intake Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the OB/GYN Intake Form from the template library. The form is ready to use immediately, but you can customize every field, add your practice logo, and adjust the layout to match your workflow.
Setup steps
- 1Choose the template. Find the OB/GYN Intake Form in the template library and click “Use this template” to add it to your account.
- 2Customize fields. Add, remove, or reorder any of the 13 fields. Set fields as required or optional based on your practice needs.
- 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
- 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
- 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.
Frequently asked questions
Is the OB/GYN Intake Form HIPAA compliant?
Yes. All Formisoft templates, including the OB/GYN Intake Form, are HIPAA compliant. Data is encrypted with 256-bit AES at rest and TLS 1.3 in transit. A Business Associate Agreement (BAA) is included on every plan.
Can I customize the fields in this template?
Absolutely. You can add, remove, reorder, or modify any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.
How do patients fill out this form?
Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.
Can I send this form automatically before appointments?
Yes. Formisoft's workflow automation can send intake forms automatically when an appointment is booked. You can set the timing (e.g., 48 hours before the visit) and include reminders for patients who haven't completed it.
Does this template work on mobile devices?
Yes. The OB/GYN Intake Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.
Start with this template
Sign up and start customizing the OB/GYN Intake Form for your practice. Set up in minutes.
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