Well Woman Exam Form
What a well woman exam form asks, with sample questions for the yearly gynecology visit.
A well woman exam form records changes since the last yearly visit, screening dates, periods, birth control, sexual health, and lifestyle before an annual exam. It's also called an annual gyn exam questionnaire.
Well woman exam form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a well woman exam 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 well woman exam form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Have you had any new diagnoses this year?Recent changes
- Have you had surgery in the last year?Recent changes
- When was your last Pap test?Screening dates
- When was your last bone density scan?Screening dates
- Do you have period problems to discuss?Periods
- Do you have regular menstrual cycles?Periods
- Are you satisfied with your birth control method?Family planning
- Are you thinking of conceiving in the next year?Family planning
- Have you had more than one partner this year?Sexual health
- Do you have any problems with intercourse?Sexual health
- Do you use tobacco or e-cigarettes?Lifestyle
- Do you wear a seatbelt at all times?Lifestyle
These are examples to read, not a form to fill in.
Well woman exam form: FAQ
What does a well woman exam form ask?
The sample questions on this page are based on the Stanford Medicine Partners well-woman exam form and an OB/GYN practice's annual health and wellness update. This page groups them into six areas: recent changes, screening dates, periods, family planning, sexual health, and lifestyle.
Who fills in a well woman exam form, and when?
The patient, before the yearly visit. The OB/GYN practice's form asks about changes since the last annual exam, such as new medicines, surgeries, or hospital stays.
Is it the same as an annual gyn exam questionnaire?
It can be. The OB/GYN practice's version is titled Annual Health and Wellness Update and is filled in for the annual exam.
What is the form for?
The Stanford Medicine Partners form says its questions help the provider decide which recommended services to offer at the visit.
Does it ask about family history?
Yes. The Stanford Medicine Partners form asks whether an immediate family member was diagnosed with breast, ovarian, colon, or other cancer in the last year.
What happens after the form is completed?
The practice's team reviews the updates before the exam. AI Doctor only collects the answers and does not choose which screenings the patient needs.
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.
