🟠 Pre-OBGYN Consultation Screening QuizPlease complete this confidential assessment to help us understand your health and provide the best care possible tailored to you.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number * visit> Have Have Date of Birth *What is the reason for your visit> *Annual Well Woman ExaminationPap Smears & Cervical Cancer Screening and TreatmentHPV VaccinationFertility EvaluationFertility treatmentSTI Screening & TreatmentBreast Health AssessmentContraceptive Counselling & Family PlanningMenstrual DisordersPelvic Pain EvaluationFibroid ManagementOvarian Cyst ManagementEndometriosis CarePolycystic Ovary Syndrome (PCOS/PMOS) ManagementVaginal Infections & Vaginal HealthPremenstrual Syndrome (PMS/PMDD)Perimenopause & MenopauseHormone Replacement Therapy (HRT/MHT)Post menopausal bleedingAdolescent GynaecologyPreconception CounsellingAntenatal CareAntenatal Ultrasound AssessmentPregnancy Loss & Miscarriage CareDelivery Services (vaginal & c-section)Postpartum Care & RecoveryHysteroscopyEndometrial and Vulval BiopsiesGenital wart removalGenital cyst removalO-Shot (PRP injections)ColposcopyCervical cryotherapyCervical biopsyLLETZ ProceduresMyomectomyHysterectomyOvarian SurgeryMenstrual Health — Are your periods:Regular (monthly)Irregular (missed periods)When was your last Pap smear? Have you ever had an abnormal Pap result? (Yes/No)YesNoReproductive Health — Have you been pregnant before? (Yes/No)YesNoReproductive Health — Any history of:MiscarriageFibroidsPregnancy ComplicationsEndometriosisPCOSDo you use contraception? (Yes/No)YesNoIf yes, specify contraception Do you smoke? (Yes/No)YesNoDo you have any chronic medical conditions?Goals for Visit — What would you like help with today?DiagnosisFertility guidanceBirth control optionsPregnancy careGeneral wellnessSubmit Assessment
