Are you a women’s healthcare provider that regularly screens new patients? If so, then you need the OBGYN Patient History Form Template from WPForms.
Why Should I Use an OBGYN Patient History Form Template?
If you’re a healthcare provider, you need this form template.
An OBGYN Patient History Form serves as a crucial tool for OBGYN healthcare providers to assess a patient’s overall health, identify potential risk factors, make accurate diagnoses, and develop appropriate treatment plans.
On our OBGYN Patient History Form, the user or healthcare provider starts by entering the patient’s personal details and contact information. The form then gathers the patient’s insurance and physician information.
Next, the form user selects the reason for the patient’s visit from 4 options in a drop-down menu. These options include:
- Prenatal Appointment
- Birth Control Consultation
- Annual Visit
- Mammogram
- Other
If the user selects Other, then a separate text box will appear where they can type in their answer.
The form user then makes a contraceptive use selection from another drop-down menu, with options that include:
- None
- Pill
- IUD
- Family Planning
- Other
Once again, when Other is selected, a field appears where the form user can write in their answer.
The OBGYN Patient History Form Template then collects personal health information about the potential patient, including any medications they’re taking.
Lastly, the form user encounters 4 large spaces where they’ll enter their responses to the following prompts:
- Physical Exam Findings
- Laboratory Results
- Diagnostic Imaging Results
- Treatment Plan
- Follow-up Instructions
Get started with WPForms today to create and customize your own OBGYN Patient History Form. Signing up with WPForms gives you access to this and hundreds of other pre-made templates.
