Pelvic Health History Form - PatientPop 2026

1. Click ‘Get Form’ to open the Pelvic Health History Form in our editor.
2. Begin by filling out your contact information, including your legal name, date of birth, email, and phone number. Select how you prefer to be addressed and your preferred language.
3. Next, provide details about your referring provider, including their name and contact information. Indicate how many healthcare providers you have seen for pelvic pain.
4. In the demographic section, check all applicable boxes regarding your race, relationship status, sexual practices, living situation, education level, and employment status.
5. Proceed to the medical history section where you can list any medical problems along with their diagnosis year and control status.
6. Continue through the surgical history and menstrual/birth control sections by checking relevant options and providing additional details as needed.
7. Complete the remaining sections on allergies, medications, pregnancy history, family history, pain description, and any additional symptoms or diagnoses.

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