A prenatal intake form with a row for every pregnancy, not a single line

The first visit is long enough already

A first obstetric appointment is one of the longest in outpatient care, and most of it is history. The prenatal intake form the practice hands out is supposed to absorb that work, and usually cannot, because it was built on a general new-patient template: one box for previous pregnancies, one box for medications, nothing at all about who is coming to appointments, and no room to write. What is available online rarely helps — static PDFs, a photocopy of another practice's packet, or a template page that asks for an email address before it shows you anything. This preset is written for prenatal onboarding rather than adapted from a general intake, and it opens populated and ready to use. Every label, instruction and section is editable, a US Letter PDF is available the moment the page loads with no account required, and once you change anything a new PDF is generated from your version rather than the original — so the packet you photocopy for the front desk is the one you designed.

• Built for HIPAA-compliant workflows

• Free to start — 50 patient actions each month

Previous pregnancies belong in rows

This is the section that separates a prenatal form from every other intake, and it is the one generic templates get wrong. A patient with four previous pregnancies does not have four times as much to say about a single ruled line — she has four separate records, each with its own year, outcome, how many weeks she reached, how the baby was born, birth weight, and what if anything went differently. Squeeze that into one box and you get x3, all fine, which tells the clinician almost nothing and gets asked again in the room five minutes later. This preset repeats the block instead: one row per pregnancy, with as many rows as you choose to print. Because nobody knows in advance how many a patient will need, most practices set four and add a continuation line. The same repeating structure carries current medications and allergies, which are the other two fields that never fit. Everything is recorded as the patient reports it — the form does not calculate a due date, confirm dating, or interpret anything about the pregnancy, all of which happens at the visit.

One document, whether you call it intake or history

Staff search for this under two names and usually mean overlapping things. Some want a prenatal history form, meaning the obstetric and medical background; others want the whole new-patient packet, meaning contact details, insurance and provider background as well. Splitting those into two pieces of paper only means the patient writes her name twice, so the prenatal intake history sits inside the same document here and you delete whichever half your practice already collects elsewhere. What the full preset covers: name, preferred name, date of birth and contact details, plus how the practice may contact her and whether it is safe to leave a message. Insurance and responsible party. The pregnancy section, including the date of her last menstrual period as she reports it and any care she has already received and from whom. Obstetric history as repeating rows. Gynecological and general medical history, surgeries, medications including anything over the counter, allergies and reactions. Family history on both sides where the practice acts on it. Then the people and logistics that matter far more here than on any other intake: who comes to appointments, who may be given information, whether an interpreter is needed, how far she travels, other children at home, and the pediatric provider she plans to use after the birth — a line that otherwise gets chased at thirty-six weeks.

Ask for less on paper, and ask the hard questions in the room

Prenatal intake collects some of the most sensitive information a practice ever holds, and the honest test for every question is short: does anyone do something with this answer at the first visit? If not, it is not thoroughness, it is a liability sitting in a filing cabinet. Two categories deserve a deliberate decision rather than a default. The first is history a patient may find painful to write down — previous loss, termination, fertility treatment — which many practices keep on the form but introduce with a plain line explaining why it is asked and who reads it. The second is anything approaching a safety, mood or substance question. A take-home form gets completed at a kitchen table where somebody else may be standing behind her, and screening tools have their own administration and scoring rules that no printed template can honour. Those conversations belong to a clinician in a room with the door closed, and this preset deliberately leaves them there. Nothing on the form is scored, rated, categorised or flagged.

Edit it, then download exactly what you built

Rename the form, rewrite any question in your own words, mark fields required or optional, change how many pregnancy rows print, and add, duplicate, reorder or remove whole sections. A midwifery practice and a hospital-affiliated obstetric group want visibly different documents from the same starting point, and a practice that already captures insurance at the desk should simply delete that half rather than ask twice. A default PDF is ready immediately and a fresh one is generated after every change, so what you print matches what is on screen. It sets on US Letter with real writing space, breaks cleanly across pages, and reset restores the original preset. Nothing typed into the builder is sent to analytics, and because this is a public tool, build the blank form here rather than entering a real patient's details.

A two-obstetrician practice forty minutes from the hospital

A small obstetric practice — two obstetricians, a nurse practitioner and one person on the phones — spent an afternoon on their packet. They set the previous-pregnancy rows to four, having watched the nurse rewrite one crowded line into the chart at every new-patient visit. They moved three questions off the take-home form entirely, agreeing that anything touching mood, safety or substance use would be asked by a clinician at the appointment rather than answered at a kitchen table. They added a short block asking who comes to appointments and who may be given information, which had been running on memory and goodwill. They added one line for the pediatric provider and stopped chasing it in the third trimester. And they put a plain sentence at the top of the history section explaining why the practice asks about previous pregnancies and who reads the answers. The packet got shorter, not longer. The first visit now starts with the clinician reading rather than transcribing.

What the form records, and what it never decides

Everything here is reported by the patient and recorded exactly as she gives it. The form performs no assessment of any kind: it produces no risk score, assigns no risk category, does not determine or confirm gestational age or a due date, offers no diagnosis, makes no triage or urgency decision and recommends nothing about care. All of that is the work of the obstetric provider, and no printed template can stand in for it. Have a clinician review the question set for the patients your practice actually sees, and have your attorney review any consent, financial responsibility or communication-permission wording you add, since that varies by state. DocRepute is HIPAA-focused and built for HIPAA-compliant workflows, with BAA availability planned at launch.

When the paper packet starts costing more than it saves

Take the PDF today — it is genuinely free and there is nothing to sign up for. What tends to happen next is that someone works out how many hours a week go into printing, deciphering and re-keying that packet across every new obstetric patient. The same structure can run as digital intake instead: the patient gets a link, completes it at home in her own time with the sections you kept, and your practice receives a typed, structured record before she arrives rather than a clipboard as she leaves. DocRepute is in early access ahead of launch and free to start on 50 action credits a month — creating, editing and publishing forms and surveys costs nothing at all, and a credit is used only when a patient completes a regular intake submission or a standard survey. There is no AI on the free path; practice-approved AI intake and conversational surveys sit on the paid plans, always inside the questions your practice wrote.