IUD Insertion Pre-Visit Form
What an IUD insertion pre-visit form asks, with sample questions on pregnancy history, periods, and current birth control.
The IUD insertion pre-visit form on this page covers pregnancy history, periods, current birth control, gynecologic history, medicines, and allergies asked before an IUD visit. The questions come from a Canadian IUD patient history form and a US IUD placement protocol.
IUD insertion pre-visit form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an IUD insertion pre-visit form in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample IUD insertion pre-visit form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Have you ever been pregnant?Pregnancy history
- Have you ever had a C-section?Pregnancy history
- When did your last period start?Periods
- How long is your usual menstrual cycle?Periods
- What birth control method do you use now?Current method
- Which IUD do you have now, if any?Current method
- Have you ever had a sexually transmitted infection?Gynecologic history
- Were you ever treated for a precancerous cervical lesion?Gynecologic history
- Do you take medicines on a regular basis?Medicines
- Which medicines do you take?Medicines
- Are you allergic to any medicines?Allergies
- Are you allergic to copper?Allergies
These are examples to read, not a form to fill in.
IUD insertion pre-visit form: FAQ
What does an IUD insertion pre-visit form ask?
The sample questions on this page are built from a Canadian IUD patient history form and a US IUD placement protocol. This page groups them into six areas: pregnancy history, periods, current method, gynecologic history, medicines, and allergies.
Who fills in an IUD insertion pre-visit form?
The patient, before the IUD visit. The Canadian form also asks whether a hormonal IUD is wanted for a purpose other than birth control.
Does it ask about an IUD already in place?
Yes. The Canadian form asks what kind of IUD the patient has now and how many years it has been in place.
What history does the US protocol list?
The Clinical Training Center for Sexual and Reproductive Health protocol has a client intake step. It lists the last period, pregnancy history, current conditions, prior surgery, and gynecologic and sexual history.
Is there an IUD insertion pre-visit form template?
The sample questions on this page show a typical set.
What happens after the form is completed?
The clinician reviews the answers at the IUD visit. AI Doctor only collects them; counseling, consent, and the procedure stay with the clinician.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
