New OB Patient Intake Form
What a new OB patient intake form asks, with sample questions on pregnancy, genetic, medical, and family history.
A new OB patient intake form records menstrual, pregnancy, genetic, medical, and family history, plus lifestyle, when a patient starts obstetric care. It's also called a new OB intake or a prenatal intake.
New OB patient intake form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a new OB patient intake 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 new OB patient intake form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- When did your last menstrual period start?Menstrual history
- How many days does your period usually last?Menstrual history
- How many times have you been pregnant?Pregnancy history
- Did you have complications in a past pregnancy?Pregnancy history
- What is your ethnic background?Genetic history
- Has a relative had cystic fibrosis or sickle cell?Genetic history
- Have you ever had complications with anesthesia?Medical history
- Would you accept a blood transfusion in an emergency?Medical history
- Has a close relative had blood clots?Family history
- Has a parent or sibling had high blood pressure?Family history
- Do you smoke, and how much?Social history
- How many alcoholic drinks do you have per week?Social history
These are examples to read, not a form to fill in.
New OB patient intake form: FAQ
What does a new OB patient intake form ask?
The sample questions on this page are based on two versions of Weill Cornell Medicine's New Obstetrics Patient Intake Form. This page groups them into six areas: menstrual history, pregnancy history, genetic history, medical history, family history, and social history.
Who fills in a new OB patient intake form?
The patient. The Weill Cornell form asks patients to answer every question as it applies to them, and it is added to the medical record.
Does it ask about genetic history?
The Weill Cornell form asks about ethnic background and family history of conditions such as cystic fibrosis, hemophilia, or Down syndrome. It asks the same of a partner, if that applies.
Does it ask about blood transfusion?
Yes. The Weill Cornell form asks whether the patient would accept a blood transfusion in a life-threatening situation.
Is there a new OB patient intake form template?
The sample questions on this page show a typical set.
What happens after the form is completed?
A physician reviews it. The Weill Cornell form ends with a line for the reviewing doctor's name and the date.
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.
