Get Pelvic Assesment

This guide provides a comprehensive overview of how to fill out the Pelvic Assessment online. Following the detailed instructions will ensure that you complete the form accurately and efficiently.

Follow the steps to complete your Pelvic Assessment online.

1. Press the ‘Get Form’ button to access the Pelvic Assessment form and open it in your preferred online editor.
2. Begin by filling in your contact information, including your name, birth date, and chart number. Ensure that your phone numbers (work, home, and cell) are accurate.
3. Describe your pain problem in detail. If necessary, use a separate sheet to clearly communicate all relevant information.
4. Indicate your thoughts on the cause of your pain and whether there was an event related to its onset. Use the provided checkbox to answer 'Yes' or 'No.' If applicable, specify the event.
5. Record how long you have been experiencing the pain by filling in the years and months.
6. Utilize the 10-point scale to rate your pain levels for each symptom listed in the assessment. Mark the appropriate level on the provided scale.
7. Provide details about treatments or providers you have previously consulted regarding your pain. Check all relevant options from the list provided.
8. Utilize the pain maps section to shade the areas of pain on your body and assign a number from 1 to 10 to the sites of pain.
9. Complete the demographic information section, including your relationship status, who you live with, and your education background.
10. Ensure to list all surgical history relevant to chronic pelvic pain, as well as additional surgeries, including the year, type of procedure, and findings.
11. Document any medications related to your pain condition, including dosage and provider information, indicating whether they were effective.
12. Fill in your obstetrical history, including the number of pregnancies and any complications experienced.
13. Complete the medical history section, including allergies, previous hospitalizations, and major accidents.
14. Continue by answering questions related to your menstrual, gastrointestinal, and urinary symptoms.
15. Share any coping mechanisms that you find helpful and indicate who you talk to about your pain.
16. Complete the sections regarding sexual and physical abuse history respectfully and thoughtfully.
17. Provide your responses to the Short-Form McGill pain questionnaire regarding the type of pain you experience.
18. Answer the Pelvic Varicosity Pain Syndrome questions to give additional context to your symptoms.
19. Review your completed form for accuracy and completeness. Once satisfied, you can save changes, download, print, or share the document as necessary.

Complete your Pelvic Assessment online today to ensure a thorough evaluation of your condition.