Postpartum Depression Screening Form

Comprehensive Postpartum Mental Health Screening for New Mothers

Welcoming a new baby is a life-changing experience, but for many mothers, the postpartum period can bring unexpected challenges. Postpartum depression affects up to 1 in 7 new mothers, making early screening and support absolutely essential. This Postpartum Depression Screening Form template is designed specifically for healthcare providers, mental health professionals, and maternal health clinics offering telehealth services to identify mothers who may need additional support during this vulnerable time.

Why This Template Matters for Maternal Healthcare

Traditional in-person postpartum visits can be difficult for new mothers to attend—juggling newborn care, recovery, sleep deprivation, and logistics makes even simple appointments feel overwhelming. Telehealth has transformed maternal mental health care by bringing essential screening directly to mothers in their homes. This form template enables healthcare providers to conduct thorough, evidence-based assessments remotely while maintaining the clinical rigor required for proper diagnosis and care planning.

The template incorporates the Edinburgh Postnatal Depression Scale (EPDS), the gold standard screening tool validated across diverse populations worldwide. Combined with breastfeeding assessments, social support evaluations, and medication safety considerations for lactation, this form provides a holistic view of maternal wellbeing that goes beyond a simple depression checklist.

Built for Virtual Care Workflows

This Paperform template is optimized for telehealth practices, OB-GYN clinics, midwifery practices, lactation consultants, and mental health professionals specializing in perinatal mood disorders. The form can be sent to patients before their virtual appointment, allowing mothers to complete the screening at their own pace while the baby naps or during a quiet moment.

Using conditional logic, the form adapts based on responses—if concerning symptoms are flagged, additional assessment questions appear automatically. This intelligent branching ensures you gather the depth of information needed without overwhelming every patient with unnecessary questions.

What Makes This Template Clinical-Grade

The form follows evidence-based screening protocols used in maternal health:

• Complete EPDS-10 questionnaire with proper scoring methodology
• Breastfeeding assessment covering feeding method, challenges, and support needs
• Social support evaluation identifying isolation risk and available resources
• Medication safety screening for psychiatric medications during lactation
• Risk assessment including thoughts of self-harm (with immediate response protocols)
• Sleep patterns and infant care stress evaluation
• Previous mental health history collection

Each section is designed to be compassionate and non-judgmental, using language that acknowledges the reality of postpartum challenges while gathering clinical data your team needs for proper care planning.

Streamline Your Postpartum Care with Automation

Once a mother submits this screening form, Paperform's built-in integrations and Stepper workflows (stepper.io) can automatically route the information where it needs to go:

• Flag high-risk scores and send immediate alerts to clinical staff via email or Slack
• Populate your EHR or patient management system with screening results
• Trigger follow-up appointment scheduling for mothers who score above threshold
• Send supportive resources automatically based on specific concerns identified
• Create care coordination tasks for your clinical team in project management tools
• Generate referrals to lactation consultants, therapists, or psychiatrists as needed

For practices using Papersign (papersign.com), you can seamlessly flow from screening to consent forms for treatment or referrals, keeping all documentation connected and compliant.

Designed for Privacy and Compliance

Maternal mental health data is highly sensitive. This form template is built on Paperform's SOC 2 Type II compliant platform with robust security features. You can collect responses with encryption, store data securely, and control access through roles and permissions—essential for maintaining patient privacy and meeting regulatory requirements.

Note: While Paperform provides strong security foundations, this platform is not HIPAA compliant. Healthcare organizations requiring HIPAA compliance should implement additional safeguards or consider dedicated healthcare platforms for PHI storage.

Who Benefits from This Template

OB-GYN Practices & Midwifery Clinics: Screen all postpartum patients at 2-week, 6-week, and 3-month intervals as recommended by ACOG guidelines, without adding burden to already-busy clinic schedules.

Mental Health Professionals: Therapists, counselors, and psychiatrists specializing in perinatal mental health can use this as an intake assessment for new referrals or ongoing monitoring tool for current patients.

Lactation Consultants: Identify mothers struggling with both breastfeeding challenges and mood symptoms, enabling holistic support and appropriate referrals.

Telehealth Platforms: Virtual care providers can incorporate this screening into their postpartum care packages, ensuring no mother falls through the cracks.

Public Health Programs: Maternal health initiatives, home visiting programs, and community health workers can use this form to systematically screen mothers in underserved communities.

The Real Impact of Early Screening

Postpartum depression doesn't just affect mothers—it impacts infant bonding, child development, family dynamics, and long-term maternal health. Early identification through systematic screening can be life-changing, connecting mothers to therapy, medication, support groups, and practical resources before symptoms become severe.

This form template gives your practice a professional, efficient, and compassionate tool to make that screening happen consistently—whether your patient is across town or across the country.

Easy to Customize, Beautiful to Use

Unlike rigid survey tools or clunky medical forms, Paperform's doc-style editor lets you adjust this template to match your practice's specific protocols. Add your clinic branding, modify question wording to match your patient population, include custom resources or referral pathways, and adjust the visual design to feel warm and supportive rather than clinical and cold.

The form works beautifully on any device—mothers can complete it on their phones while feeding the baby, on a tablet from the couch, or on a computer when they have a quiet moment. The Guided Mode option presents one question at a time, reducing overwhelm for mothers who may already be struggling with focus and concentration.

Get Started with Evidence-Based Postpartum Screening

Maternal mental health care starts with asking the right questions at the right time. This Postpartum Depression Screening Form template brings clinical best practices into an accessible, automated, and compassionate digital format that works for both providers and patients.

Whether you're a solo practitioner expanding into telehealth, a large OB practice standardizing your postpartum protocols, or a mental health clinic building a maternal health specialty, this template provides the foundation for systematic, high-quality screening that truly supports new mothers when they need it most.