Abnormal Pap Smear Abnormal Uterine Bleeding Adolescent Gynecology
Bladder / Anal Incontinence
Bladder or pelvic pain
Breast Health Contraception Endometriosis Infertility
Sexual Dysfunction Sexually Transmitted Diseases
Urogenital Anomalies / Vaginal Cosmesis
Uterine Fibroids Women's Health and Annual Well Exams
If you feel you have more complex pelvic floor issues
that require additional history,
please complete theUrogynecology History questionnaire below
Please fill out these following additional questionnaires that may specifically relate to the following problems:
If you suffer from bladder incontinence or pelvic organ prolapse and have issues related to activity or sexual intercourse, please complete the PFIQ and PISQ questionnaires .
If you suffer from anal incontinence, constipation, diarhhea, irritable bowel syndrome, or painful stooling, please complete the FIQL,PFIQ, PFDI, and Bowel Diary.
If you suffer from vulvovaginal pain, please complete the Vulvodynia questionnaire.
If your condition is causing great distress in your quality of life or you are concerned about depression, please complete tha SF-36and Depression questionnaires.
Patient Questionnaires and Histories
Many of the patient intake questionnaires and histories found in the patient registration packets may also be independently downloaded below. They may be completed prior to your first visit or to update information on an as needed basis.
In addition, there are patient informational forms available for downloading based on educational needs for certain conditions.