Get Intake Form Pregnancy & Std/sti - Obria.org

Completing the Intake Form for Pregnancy and STD/STI from Obria.org is an important step in receiving the appropriate care. This guide provides clear, step-by-step instructions to assist you in filling out the form effectively and accurately.

Follow the steps to complete your Intake Form with ease.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering your name in the designated field. Ensure spelling is accurate to avoid any issues with your care.
3. Fill in the date of form submission. This section may include today's date as well as the date of your last menstrual period if applicable.
4. Indicate whether you have any allergies by selecting 'Yes' or 'No.' If yes, list the specific allergies and describe any reactions you experience.
5. Detail any medications you are currently taking, including dosages, to help the healthcare provider understand your health status.
6. State any diagnosed medical conditions by selecting 'Yes' or 'No.' If yes, provide the specifics of those conditions.
7. Indicate lifestyle choices by selecting all that currently apply, such as smoking, alcohol use, and drug use.
8. Provide the age you were when you became sexually active, as this information can be relevant for your health assessment.
9. Confirm whether you currently feel safe at home and disclose any history of abuse if applicable. This section is crucial for your wellbeing.
10. Describe your methods for preventing STDs and unplanned pregnancy in the fields provided.
11. For the pregnancy section, select if you are there for pregnancy testing or not. If yes, enter the date of your last menstrual period and provide details about your menstrual cycle.
12. Check any symptoms you may be experiencing related to pregnancy.
13. If you have taken a pregnancy test, note the results and any previous pregnancies or abortions.
14. In the STD/STI section, choose the tests you would like to undergo and confirm your testing history.
15. Answer questions related to sexual activity, including your partners' identities and any symptoms you may have.
16. Review all provided information to ensure completeness and accuracy.
17. Once completed, save your changes, and you can share, download, or print the form as needed.

Complete your Intake Form online today to receive the care you deserve.