Self-Administered Patient History Form and Sample Physical Exam Form

Self-administered medical history forms save time in the exam room and serve as a jumping-off point for the patient/provider interview. This self-administered Patient History Form was developed by the PPFA Clinicians Workgroup and can be adapted for use in your workplace setting.

Download the Patient History Form and the Physical Exam Form.

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Association of Reproductive Health Professionals – East
1901 L Street, NW, Suite 300, Washington, DC 20036
(202) 466-3825 | ARHP@arhp.org

Association of Reproductive Health Professionals – West
1330 Broadway, Suite 1100, Oakland, CA 96412
(202) 466-3825 | ARHP@arhp.org

Looking for medically accurate, up-to-date, evidence-based educational programming for health care providers and materials for patients on all reproductive health topics, including abortion, contraception, HPV, menopause, menstruation, pregnancy, sexuality? Look no further than the Association of Reproductive Health Professionals (ARHP) – the leading source for trusted medical education and information on reproductive and sexual health.

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