Pelvic Floor Dysfunction Assessment Form

What is a Pelvic Floor Dysfunction Assessment Form?

A pelvic floor dysfunction assessment form is a specialized healthcare questionnaire designed to help medical professionals evaluate symptoms related to pelvic floor disorders before a patient's visit. This comprehensive assessment captures critical information about bladder control issues, bowel function concerns, pain locations, and the impact these symptoms have on daily life.

Who Needs This Form?

This assessment is essential for urogynecology practices, pelvic health physiotherapy clinics, colorectal specialists, and women's health centers. Physical therapists specializing in pelvic floor rehabilitation, urologists, gynecologists, and gastroenterologists regularly use these forms to gather detailed symptom histories before initial consultations or treatment planning sessions.

Why Use Paperform for Pelvic Floor Assessments?

Paperform makes it simple to create professional, HIPAA-compliant pre-visit assessment forms that patients can complete from home before their appointment. The intuitive design ensures patients feel comfortable answering sensitive questions about bladder, bowel, and sexual health concerns.

With conditional logic, the form adapts based on each patient's responses—asking relevant follow-up questions only when needed, which reduces form fatigue and improves completion rates. For example, if a patient indicates experiencing urinary incontinence, they'll automatically see additional questions about frequency and severity without cluttering the form for those without that specific symptom.

The visual editor allows you to maintain your clinic's brand while creating a reassuring, professional experience. You can integrate directly with your practice management system, electronic health records, or patient communication platforms, ensuring symptom data flows seamlessly into your existing workflow.

For practices looking to further streamline their intake process, Stepper can automate what happens after submission—automatically flagging urgent cases, routing assessments to the appropriate specialist, or triggering appointment confirmation emails based on symptom severity.

Whether you're a pelvic health physiotherapist building your practice or a large women's health center managing hundreds of patient assessments monthly, this Paperform template provides a dignified, thorough way to understand your patients' needs before they walk through your door.