Sexual Health History Form
What a sexual health history form asks, with sample questions for clinic staff.
A sexual health history form records why the patient is visiting, any symptoms, recent partners, protection, and vaccines before a sexual health visit. It's also called an STI screening questionnaire.
Sexual health history form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a sexual health history 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 sexual health history form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- What brings you to the clinic today?Visit reason
- Are you here for screening with no symptoms?Visit reason
- Do you have discharge, itching, or odor?Symptoms
- Do you have a rash, sore, or bump?Symptoms
- When did you last have sex?Recent sex
- Is a partner here for their own visit?Recent sex
- How many partners have you had this past year?Partners
- Are your partners female, male, or both?Partners
- How often do you use condoms?Protection
- Are you using a method to prevent pregnancy?Protection
- Have you had the HPV vaccine?Prevention
- Are you interested in medicine to prevent HIV?Prevention
These are examples to read, not a form to fill in.
Sexual health history form: FAQ
What does a sexual health history form ask?
The sample questions on this page are based on the Sexual Health History form of the Fairfax County Health Department in Virginia. This page groups them into six areas: visit reason, symptoms, recent sex, partners, protection, and prevention.
Who fills in a sexual health history form, and when?
The patient, at the visit. The Fairfax form asks patients to complete it alone and return it to the front desk.
Is it the same as an STI screening questionnaire?
Close. The Fairfax form says it helps identify the appropriate testing options, and it also asks about birth control, vaccines, and general health.
Does the form use inclusive wording?
Yes. The Fairfax form asks about birth sex, gender identity, and preferred pronouns, and whether partners are female, male, or both.
Is there a template for this form?
The sample questions on this page show a typical set.
What happens after the sexual health history form is completed?
The Fairfax form says a nurse discusses the answers and follow-up questions during the visit. AI Doctor collects the answers and does not suggest tests.
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.
