OB/GYN Intake Form: Essential Fields for Obstetric and Gynecological Practices

OB/GYN intake forms are among the most detailed in medicine. You're collecting a full medical history plus a comprehensive reproductive history, and the sensitivity of the information requires careful form design that makes patients feel comfortable rather than interrogated.

The best OB/GYN intake forms are thorough without being exhausting, and they use conditional logic to show only what's relevant to each patient's situation.

Demographics and Contact Information

Full name, date of birth, address, phone, email, emergency contact. Include preferred pharmacy and referring provider, if applicable.

Reason for Visit

Let patients indicate the primary reason:

Annual well-woman exam
Pregnancy confirmation or prenatal care
Contraception consultation
Irregular periods or menstrual concerns
Pelvic pain
Fertility consultation
STI screening
Menopause management
Other gynecological concern

This selection should drive conditional logic throughout the rest of the form. A patient presenting for prenatal care needs different follow-up sections than one seeking contraception counseling.

Menstrual History

Core reproductive health data:

Age at first period (menarche)
Date of last menstrual period (LMP)
Cycle length and regularity
Duration of bleeding
Flow heaviness (light, moderate, heavy)
Painful periods: severity and impact on daily activities
Intermenstrual bleeding or spotting
Menopause status, if applicable (last period date, symptoms)

Pregnancy History

Use the obstetric shorthand that clinicians understand, but make it patient-friendly:

Number of pregnancies (gravida)
Number of full-term deliveries
Number of preterm deliveries
Number of miscarriages or abortions
Number of living children
For each prior pregnancy: year, delivery method (vaginal/C-section), complications, birth weight

This section should only expand if the patient indicates prior pregnancies. Conditional logic prevents showing a detailed pregnancy table to a nulligravid patient.

Contraception

Current method (or none)
Past methods used and reasons for discontinuation
Interest in changing or starting contraception
Satisfaction with current method

Sexual Health and STI Screening

Handle this section with clear, neutral language:

Sexually active (yes/no)
Partners (male, female, both)
Number of partners in the past 12 months
History of STIs (type, treatment, year)
Date of last STI screening
Concerns about current symptoms

Pap Smear and Cancer Screening

Date of last Pap smear
Results (normal, abnormal, ASCUS, LSIL, HSIL)
History of abnormal Pap results
History of colposcopy or LEEP procedure
HPV vaccination status
Date of last mammogram (age-appropriate)
History of abnormal mammogram findings

Gynecological Surgical History

Previous gynecological surgeries (hysterectomy, myomectomy, oophorectomy, tubal ligation, D&C, laparoscopy)
Dates and outcomes
Current gynecological conditions (fibroids, endometriosis, PCOS, ovarian cysts)

Medical History and Medications

Full medication list including supplements, vitamins, and herbal remedies. Allergy list. Relevant medical conditions, paying particular attention to thyroid disorders, diabetes, hypertension, blood clotting disorders, and autoimmune conditions, all of which affect reproductive health.

Family History

Family history with reproductive health focus:

Breast cancer (and age at diagnosis)
Ovarian cancer
Uterine cancer
Endometriosis
PCOS
Blood clotting disorders
Genetic conditions relevant to pregnancy

Insurance

Primary and secondary insurance, subscriber info, group and member ID numbers.

Consent

Consent for examination (including pelvic exam), consent for laboratory testing, HIPAA privacy notice, and e-signatures.

Building the Form

An OB/GYN intake form is one of the most complex specialty forms to build, which is exactly where Formisoft's AI builder and conditional logic shine. Generate the base structure with AI, then layer in conditional sections: pregnancy history expands only for patients with prior pregnancies, prenatal-specific questions appear only for pregnancy visits, and menopausal screening shows only for age-appropriate patients.

The result is a form that's comprehensive for the clinician but feels personalized to the patient. Send it via secure email before the appointment so patients can complete it privately, without a waiting room audience.

Build your OB/GYN intake form with Formisoft, free to try.