Streamline Chronic Pelvic Pain Assessments with Paperform

Chronic pelvic pain syndrome (CPPS) affects millions of people worldwide and requires a thorough, multidimensional assessment to develop effective treatment plans. This Chronic Pelvic Pain Syndrome Assessment Form is designed for pain clinics, urology practices, pelvic health specialists, and multidisciplinary care teams who need to capture detailed patient information efficiently and compassionately.

Why use this template?

Traditional paper-based CPPS assessments can be time-consuming to administer and difficult to analyze. With Paperform, you can create a professional, HIPAA-alternative digital assessment that patients can complete before their appointment—saving valuable consultation time and ensuring you have comprehensive information from the start.

This template captures everything you need for a complete CPPS evaluation: pain location mapping, severity and characteristics, urological symptoms, bowel function, sexual health impact, psychological factors including anxiety and depression screening, and quality of life measures. The structured format ensures consistency across assessments while conditional logic reveals relevant follow-up questions based on patient responses.

Perfect for healthcare professionals

Whether you're a urologist, pelvic floor physical therapist, pain management specialist, or running a multidisciplinary pelvic pain clinic, this template helps you gather the clinical data needed to make informed referrals and develop personalized treatment plans. The form works seamlessly for practices treating both men and women with CPPS, prostatitis, interstitial cystitis, endometriosis-related pain, and other chronic pelvic pain conditions.

Enhance your workflow with automation

Take your patient intake process further by connecting this form to your practice management system. With Stepper (stepper.io), Paperform's AI-native workflow builder, you can automatically route completed assessments to the appropriate specialists, trigger appointment scheduling for high-priority cases, update your electronic health records, and notify your care team when urgent intervention may be needed.

Paperform is trusted by healthcare providers worldwide for creating professional patient forms that respect privacy and deliver a better experience. While this template isn't HIPAA compliant, it provides a robust foundation for pelvic pain assessment that can be customized to your practice's specific protocols and compliance requirements.