Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente 2025

See details

4.4 out of 5

238 votes

The document is a Prenatal Intake Questionnaire designed to collect comprehensive information from expectant mothers regarding their personal details, medical history, obstetric history, and current pregnancy circumstances. It includes sections for demographic information, past medical conditions, living situations, and details about previous pregnancies.

Here's how it works

01. Edit your kaiser questionnaire online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information, including your name, address, phone number, and date of birth. This section is crucial for establishing your identity and contact details.
Next, provide emergency contact information. Include the name and phone number of someone who can be reached in case of an emergency.
Complete the sections regarding your marital status, occupation, and employer details. These fields help healthcare providers understand your background.
In the OB/GYN status section, indicate the first day of your last period and whether you are currently breastfeeding. This information is vital for assessing your pregnancy timeline.
Proceed to the pregnancy circumstances section. Here, describe your living situation and any relevant details about your partner or support system.
Fill out the past medical history questionnaire by checking any medical conditions you have experienced. This helps in understanding potential risks during pregnancy.
Finally, document your obstetric history by detailing previous pregnancies. If necessary, make copies for additional pregnancies beyond six.

Start using our platform today to complete your Prenatal Intake Questionnaire effortlessly!

See more Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente versions

We've got more versions of the Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente form. Select the right Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (169 Votes)
2013	4.4 Satisfied (238 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What is a prenatal intake appointment?

A clinician will perform a physical exam that includes a exam, pelvic exam, and Pap test if youre due for one. Youll also talk about your personal medical history. Your clinician will ask about your family health history as well. Your clinician will discuss how to stay healthy throughout your pregnancy.

What happens at the first prenatal appointment with Kaiser?

Lab pregnancy tests If you prefer to take a test at Kaiser Permanente, you can come into the lab for a test. You dont need a lab order from your clinician. We recommend that you make a lab appointment online or by phone. If youre bringing a sample into the lab, your first morning is preferable.

Do you bring your husband to your first prenatal visit?

Your prenatal visit will also include a physical examination. Because of this, it is recommended that you wear loose, comfortable clothing that can be easily removed from the waist down or adjusted to facilitate the pelvic exam or transvaginal ultrasound.

What happens at a prenatal intake?

Your health care provider might do a physical exam, including a exam and a pelvic exam. You might need a Pap test, depending on how long its been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid.

Do you get drug tested at your first prenatal appointment?

You can typically count on a test during your first prenatal appointment, and periodically throughout your pregnancy at a minimum if youre considered a low-risk pregnancy.

How do I get a pregnancy test from Kaiser?

As a Kaiser Permanente member, prenatal care and all necessary tests and services related to your pregnancy are covered under most plans. Your benefits dont limit your hospital stay after your baby is born.

Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente 2025

Here's how it works

How to use or fill out Prenatal Intake Questionnaire - Kaiser Permanente - mydoctor kaiserpermanente