Pregnancy & Obstetric History Form
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Pregnancy & Obstetric History Form
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A thorough obstetric history is critical for safe prenatal care and delivery planning. This form allows OB/GYN practices to capture a patient's complete reproductive timeline, including the number of pregnancies, live births, miscarriages, and terminations. Providers gain the clinical context they need to assess risk factors and tailor care plans for each trimester.
The form includes sections for prior delivery methods, gestational complications such as preeclampsia or gestational diabetes, birth weights, and neonatal outcomes. Patients can also document their menstrual history, contraceptive use, and any fertility treatments received. These details help clinicians identify patterns and anticipate potential complications in current or future pregnancies.
From first-time expectant mothers to patients with complex obstetric histories, this form gives your practice a structured, consistent way to collect the information that drives better maternal and neonatal outcomes. It integrates seamlessly with prenatal intake workflows and can be sent digitally before the first appointment.
What's included
- Gravida, para, and abortion tracking fields
- Prior delivery method and complication checklists
- Gestational diabetes and preeclampsia screening questions
- Menstrual and contraceptive history sections
- Fertility treatment documentation
- Blood type and Rh factor recording
- E-signature capture
- Structured medication list with dosage and frequency tracking
Who uses this template
- First prenatal visit intake for new OB patients
- Comprehensive obstetric history for high-risk pregnancy assessments
- Pre-conception counseling and fertility consultations
- Postpartum follow-up documentation
All form fields
16 fields across 3 pages. Customize any field after signing up.
How to use the Pregnancy & Obstetric History Form
Getting started with this template takes just a few minutes. Sign up for a free Formisoft trial, then select the Pregnancy & Obstetric History 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 Pregnancy & Obstetric History 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 16 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 Pregnancy & Obstetric History Form HIPAA compliant?
Yes. All Formisoft templates, including the Pregnancy & Obstetric History 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 16 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 Pregnancy & Obstetric History 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 Pregnancy & Obstetric History Form for your practice. Set up in minutes.
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