Endometriosis Pain Assessment Form

Streamline Endometriosis Care with Pre-Visit Symptom Assessment

Endometriosis affects approximately 1 in 10 women of reproductive age, yet diagnosis often takes years. This Endometriosis Pain Assessment Form helps gynecology practices, women's health clinics, and reproductive health centers gather detailed symptom information before appointments, enabling more focused consultations and faster paths to diagnosis and treatment.

Why This Form Matters for Healthcare Providers

For gynecologists, nurse practitioners, and women's health specialists, understanding the full scope of a patient's endometriosis symptoms before they arrive can transform the quality of care. This comprehensive assessment captures:

• Dysmenorrhea severity using validated pain scales
• Deep dyspareunia (painful intercourse) frequency and impact
• Infertility concerns and conception history
• Bowel and bladder symptoms often overlooked in standard intake
• Quality of life impact on work, relationships, and daily activities

By collecting this information digitally ahead of appointments, providers can review cases thoroughly, prepare targeted questions, and make the most of limited consultation time.

Built for Women's Health Workflows

This Paperform template is designed specifically for healthcare practices that want to modernize patient intake while maintaining clinical rigor. The form guides patients through a structured assessment that covers:

• Menstrual cycle patterns and pain characteristics
• Location and timing of pain throughout the cycle
• Impact on sexual health and relationships
• Gastrointestinal and urinary symptoms
• Previous treatments and their effectiveness
• Current medications and allergies
• Fertility history and family planning goals

The conversational flow uses conditional logic to ask follow-up questions only when relevant, preventing survey fatigue while capturing comprehensive clinical detail. For example, patients who indicate painful intercourse receive targeted questions about frequency and severity, while those not sexually active skip this section entirely.

Seamless Integration with Healthcare Systems

Paperform makes it simple to connect this assessment into your existing practice management workflow. Submissions can automatically flow into your EHR system via integrations with platforms like Practice Fusion, Kareo, or custom systems through webhooks and APIs. You can also route submissions to Google Sheets or Airtable for easy review before appointments.

For practices using patient communication tools like SimplePractice, Jane App, or Cliniko, this form can be sent as part of appointment confirmation sequences, ensuring patients complete their assessment at home rather than in the waiting room.

If your practice uses Stepper, Paperform's AI-native workflow builder, you can automate the entire pre-visit preparation process. When a patient submits their assessment, Stepper can automatically flag high-priority cases (severe pain scores, urgent fertility concerns), send the submission summary to the treating physician via Slack or email, update appointment notes in your practice management system, and trigger follow-up communications if additional tests or specialist referrals are needed.

Professional, On-Brand Patient Experience

First impressions matter in healthcare. This template offers a clean, professional design that can be customized to match your practice's branding—adjust colors, fonts, and add your logo to create a cohesive experience from website to waiting room.

The form works beautifully on mobile devices, which is essential since many patients complete intake forms on their phones between work commitments. The HIPAA-conscious design avoids collecting unnecessary identifying information until the appropriate security measures are in place (Paperform itself is not HIPAA compliant, but can be used with appropriate Business Associate Agreements and security protocols depending on your implementation).

Save Time, Improve Outcomes

For busy gynecology practices, OB/GYN offices, and fertility centers, time is precious. This digital symptom assessment:

• Reduces appointment time spent on history-taking by 30-40%
• Improves diagnostic accuracy with standardized pain assessment scales
• Identifies surgical candidates earlier through systematic evaluation
• Enhances patient satisfaction by demonstrating thoroughness and care
• Creates consistent documentation for insurance and specialist referrals

Patients appreciate the opportunity to thoughtfully reflect on their symptoms at home, often remembering details they might forget during in-person conversations. The structured format also helps them feel heard and understood before ever entering the exam room.

Designed for Women's Health Specialists

Whether you're a reproductive endocrinologist, pelvic pain specialist, gynecological surgeon, or general women's health provider, this template gives you the clinical detail needed to provide excellent care. The assessment includes validated pain scales commonly used in endometriosis research and clinical practice, making it suitable for practices involved in clinical trials or research protocols.

For practices offering telehealth services, this form is an essential pre-consultation tool that ensures virtual visits are as productive as in-person appointments. Combined with Paperform's secure submission handling and integration capabilities, it creates a seamless digital-first patient experience.

Get Started in Minutes

With Paperform's intuitive editor, you can customize this template to match your specific practice needs—add questions about alternative treatments you offer, adjust pain scales to those you prefer, or include practice-specific consent language. The form is ready to share immediately via direct link, embedded on your website's patient portal, or sent through email campaigns.

Trusted by healthcare practices worldwide, Paperform provides SOC 2 Type II compliance and enterprise-grade security features, giving you confidence in your digital patient communications. Start improving your endometriosis care pathway today with this comprehensive, patient-friendly assessment form.