Pelvic Pain Questionnaire
What a pelvic pain questionnaire asks, with sample questions on pain, periods, bladder, and bowel.
A pelvic pain questionnaire records how long the pain has lasted, its link to periods, bladder and bowel symptoms, treatments tried, and its effect on daily life. It's also called a pelvic pain history form or a chronic pelvic pain assessment.
Pelvic pain questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a pelvic pain questionnaire 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 pelvic pain questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- How long have you had this pain?Pain history
- Over time, is the pain better or worse?Pain history
- Are your periods painful?Periods
- Does the pain vary through your cycle?Periods
- How often do you pass urine during the day?Bladder
- Do you have problems with leaking urine?Bladder
- Are you happy with how your bowels work?Bowel
- Does your pain change after a bowel movement?Bowel
- Which medicines have you tried for the pain?Past treatment
- Have you had surgery to investigate the pain?Past treatment
- Who do you live with?Daily life
- What is your current work status?Daily life
These are examples to read, not a form to fill in.
Pelvic pain questionnaire: FAQ
What does a pelvic pain questionnaire ask?
The sample questions on this page are based on the Pelvic Pain Questionnaire of Canterbury District Health Board in New Zealand. This page groups them into six areas: pain history, periods, bladder, bowel, past treatment, and daily life.
Who fills in a pelvic pain questionnaire?
The patient, before the appointment. The Canterbury form says someone may help with reading or writing, as long as the answers stay the patient's own.
Is it the same as a pelvic pain history form?
It covers the same ground. The Canterbury form records the history of the pain itself, plus periods, bladder, bowel, contraception, medicines, past surgery, and daily life.
Why does the form ask so much before the visit?
The Canterbury form says the information allows more time in the appointment to focus on what troubles the patient most.
Does the form use a body diagram?
Yes. The Canterbury form asks the patient to shade every painful area on a body diagram and mark the worst pain with an X.
What happens after the pelvic pain questionnaire is completed?
The practice's team reviews the answers before the appointment. AI Doctor only collects them and does not judge what is causing the pain.
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.
