Endometriosis Pain Psychology Intake Form

Understanding Endometriosis Pain Through Psychological Assessment

Living with endometriosis means navigating not just physical pain, but the emotional, psychological, and relational impacts that chronic pain creates. This Endometriosis Pain Psychology Intake Form helps mental health professionals gather comprehensive information about how endometriosis affects every aspect of a patient's life—from daily functioning to intimate relationships, work productivity to mental wellbeing.

For therapists, counselors, and psychologists working with endometriosis patients, this intake form goes beyond basic health history. It explores pain severity patterns, treatment experiences, coping mechanisms, emotional impacts, and the often-overlooked relationship and intimacy challenges that accompany chronic pelvic pain.

Why Psychological Support Matters for Endometriosis

Endometriosis affects approximately 1 in 10 women during their reproductive years, yet many patients experience years of diagnostic delay, invalidation, and inadequate pain management. The psychological toll is significant: research shows elevated rates of anxiety, depression, and PTSD among endometriosis patients. Chronic pain affects self-identity, career trajectories, social connections, and intimate relationships in profound ways.

This intake form helps clinicians quickly understand:

• Pain severity and patterns – When pain occurs, intensity levels, and what triggers or relieves it
• Treatment journey – What interventions have been tried, what worked, what didn't, and any medical trauma
• Emotional and mental health impacts – Depression, anxiety, frustration, isolation, and validation concerns
• Relationship and intimacy effects – How pain impacts partnerships, sexual health, and social connections
• Current coping strategies – What the patient is already doing to manage pain and emotional distress
• Goals for therapy – What the patient hopes to achieve through psychological support

Designed for Mental Health Professionals Supporting Chronic Pain Patients

This template is ideal for:

• Clinical psychologists and therapists specializing in health psychology, chronic pain, or women's health
• Counselors working with endometriosis support groups or reproductive health clinics
• Pelvic health psychologists addressing the mind-body connection in chronic pelvic pain
• Health coaches supporting patients through treatment decisions and lifestyle management
• Pain management clinics incorporating psychological assessment into multidisciplinary care

The form uses compassionate, trauma-informed language that acknowledges the real challenges endometriosis patients face, while gathering clinical data that informs treatment planning.

Built on Paperform for Seamless Client Onboarding

Creating this intake form in Paperform means you can offer a professional, welcoming first impression that reflects the care you provide. The form can be branded to match your practice, embedded on your website, or sent as a secure link. Patients can complete it at their own pace, in their own time, before their first appointment—reducing administrative burden during sessions and allowing more time for therapeutic work.

Conditional logic ensures patients only see relevant questions (for example, relationship questions appear only if applicable), making the form feel personalized rather than one-size-fits-all. Calculation fields can create symptom severity scores that help with clinical assessment and tracking progress over time.

With Paperform's HIPAA-alternative security measures including SOC 2 Type II compliance, SSL encryption, and data residency options, you can collect sensitive health information with confidence. While Paperform is not HIPAA compliant, it provides enterprise-grade security suitable for many healthcare settings.

Automate Your Intake Workflow with Stepper

Once a patient submits their intake form, you can use Stepper to automatically:

• Send the submission to your practice management software or EHR system
• Create a new client record in your CRM with all intake details
• Email a welcome packet with appointment confirmation and what to expect
• Add the patient to a secure calendar booking system for their first session
• Notify your administrative team to follow up with insurance verification
• Generate a summary PDF that's added to the patient's file

This means less time on administrative tasks and more time providing the care your clients need.

Supporting Better Outcomes Through Better Assessment

A thorough intake assessment is the foundation of effective therapeutic work with chronic pain patients. This template helps mental health professionals quickly identify key concerns, validate patient experiences, and begin building the therapeutic alliance from the very first interaction.

Whether you're a solo practitioner or part of a multidisciplinary pain clinic, this Endometriosis Pain Psychology Intake Form helps you gather the right information, in a compassionate format, so you can start making a difference from session one.

Trusted by mental health professionals worldwide, Paperform makes client intake simple, secure, and professional—no coding required.