Get History Intake Form Female 8-19-09

Filling out the History Intake Form Female 8-19-09 is an important step in the fertility assessment process. This guide will provide you with detailed, step-by-step instructions on how to complete the form online, ensuring you provide the necessary information clearly and accurately.

Follow the steps to complete the History Intake Form Female 8-19-09 online

1. Press the ‘Get Form’ button to access the History Intake Form Female 8-19-09 and open it in your chosen editing interface.
2. Begin by entering the date at the top of the form. This helps to track your submission.
3. Fill in your name and Duke History number as required. Ensure correct spelling for both fields.
4. Complete the personal information section, including your marital status, social security number or history number, and your date of birth.
5. Add your partner's name and their date of birth if applicable. If you do not have a partner, specify that in the relevant section.
6. Provide your height and weight. Additionally, indicate your race and whether you identify as Hispanic or Latino.
7. Enter your contact information, including your daytime and nighttime phone numbers, and email address.
8. Complete the education level and occupation fields, which are important for understanding your background.
9. Proceed to the pregnancy history section. List the total number of pregnancies you have had and provide details for each under the specified columns.
10. Continue to the fertility history section by reporting how long you and your current partner have been trying to conceive. Indicate any past infertility with previous partners.
11. If applicable, check all tests you have undergone and provide the respective dates and results in the fields provided.
12. Move on to the gynecological history section and answer the questions regarding your menstrual and contraceptive history accurately.
13. In the medical history part, check all conditions or medical issues that apply to you and ensure to list any current medications and allergies.
14. Fill out the social history, including information about your employment, alcohol consumption, smoking habits, and exercise routines.
15. After completing all sections, review your responses to ensure accuracy and completeness.
16. Once you are satisfied with your entries, you can save changes, download the form for personal records, or print it for submission.
17. Email the completed form or bring a printed version to your appointment, as per the instructions provided.

Start filling out your History Intake Form Female 8-19-09 online today.