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Gynecology intake form

Gynecology intake 2025

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The document is a Gynecology Intake Form designed to collect comprehensive patient information, including personal details, medical history, gynecological history, family history, social habits, and review of systems. It aims to facilitate the assessment of a patient's health status and needs in a gynecological context.

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Click ‘Get Form’ to open the gynecology intake form in the editor.
Begin by entering the date, age, name, and birth date in the designated fields. This information is crucial for your medical records.
Fill in your address, including city, state, and zip code. Provide your home, cell, and work phone numbers for contact purposes.
Indicate your primary care physician's name and record your height. This data helps in assessing your overall health.
Answer questions regarding advanced directives and any specific concerns you wish to discuss with your physician.
Complete the allergies and medications sections by listing any known allergies and current medications along with their dosages.
Proceed to fill out the gynecological history section, including menstrual history and past screenings like Pap smears.
Continue through personal medical history, surgical history, family history, and social history sections by providing accurate details as requested.

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Versions	Form popularity	Fillable & printable
2007	4.8 Satisfied (141 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Should I shave before a gyno visit?

In addition to the annual or bi-annual exams, you should promptly schedule a visit with your gynecologist if you are experiencing: Unusual changes in (heavy periods, multiple skipped periods, spotting, etc.) Pelvic or vaginal pain. Any unusual vaginal or discharge.

Do gynos care if you shave?

Please dont! Shaving or waxing can cause skin irritation and your provider doesnt expect or need you to do it.