OB/GYN New Patient Intake Form
What an OB/GYN new patient intake form asks, with sample questions on periods, pregnancies, and health history.
An OB/GYN new patient intake form records the visit reason, menstrual, gynecologic and pregnancy history, and medical and family history before a first visit. It's also called OB/GYN new patient paperwork.
OB/GYN new patient intake form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on an OB/GYN new 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 OB/GYN new patient intake form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Who referred you to the practice?Visit details
- What is the reason for your visit?Visit details
- When did your last menstrual period start?Menstrual history
- At what age did your periods start?Menstrual history
- When was your last Pap test?Gynecologic history
- Have you ever had fibroids or ovarian cysts?Gynecologic history
- How many times have you been pregnant?Pregnancy history
- Did you have any pregnancy complications?Pregnancy history
- Which medicines and supplements do you take?Medical history
- Which surgeries have you had, and when?Medical history
- Has a relative had breast or gynecologic cancer?Family history
- Does anyone in your family have a bleeding disorder?Family history
These are examples to read, not a form to fill in.
OB/GYN new patient intake form: FAQ
What does an OB/GYN new patient intake form ask?
The sample questions on this page are based on Weill Cornell Medicine's obstetric and gynecology intake forms and the UCLA Health OB-GYN patient history questionnaire. This page groups them into six areas: visit details, menstrual history, gynecologic history, pregnancy history, medical history, and family history.
Who fills in an OB/GYN new patient intake form?
The patient, before the first visit. The Weill Cornell Medicine form asks the patient to answer every question that applies and becomes part of the medical record.
Does it ask about recent exams?
Yes. The Weill Cornell Medicine gynecology form asks for the date and place of the last Pap test, mammogram, colonoscopy, pelvic ultrasound, and bone density study.
Does it ask about family genetic history?
Yes. The Weill Cornell Medicine obstetric form asks about conditions in the patient's family or a partner's family, such as cystic fibrosis, sickle cell anemia, or hemophilia.
Is there an OB/GYN new patient intake form template?
The sample questions on this page show a typical set.
What happens after the form is completed?
The Weill Cornell Medicine form has a line where a physician signs it as reviewed. AI Doctor collects the answers; the care team reviews them.
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.
