The best intake form for pelvic floor physiotherapy clients

A good pelvic floor intake form captures everything you need to plan a first session and nothing the client doesn't need to type. The hard part is the second half: most generic intake builders force flat-field forms that ask everyone everything, which means clients see fields that don't apply (sometimes intimate ones that don't apply), get fatigued, and either skip or quit.

This post lays out the fields a real pelvic floor intake should capture, how to structure them conditionally so the form is short for the average client and complete for the clients who need it, and how to handle the sensitive sections in a way that respects both your clinical needs and your client's dignity. If you want the operational tooling that runs this form, the Junocal for pelvic floor specialists page covers the booking-and-intake integration.

The seven sections

A real pelvic floor intake form has seven sections, in this order:

1. Contact and basics. Name, date of birth, address, phone, email, emergency contact, primary care provider name and phone (often a GP or family physician).
2. Reason for visit. A short prompt asking the client to describe what brought them to a pelvic floor specialist in their own words. Free-text, 500-character limit.
3. Symptoms screening. Conditional follow-ups by symptom domain.
4. Pregnancy and postnatal status. Conditional on relevance.
5. Surgical and medical history. Conditional on relevance.
6. Sexual health. Optional, conditional on willingness to answer.
7. Consent and waiver. E-signature required.

Each section depends on the answers in the prior section so the form is short for the symptom-free client (who probably should not be booking a pelvic floor specialist anyway) and detailed for the client whose history needs the detail.

Section 1: Contact and basics

The standard fields. Two things worth specifying:

• Primary care provider name and phone. Not always asked, but important. If you need to refer back (or up), you have the contact ready. Optional, but most clients fill it in.
• Emergency contact. Required. Even a low-risk hands-on practice should have this for the same reason a yoga studio has it.

Section 2: Reason for visit

A short open prompt. The most common formulation works well: "In a sentence or two, what brought you to a pelvic floor specialist today?" Free text, 500 characters.

The answer here usually previews what symptom sections will matter. Read it before the session even if the structured fields below give you the same information.

Section 3: Symptoms screening

This is the section where conditional logic earns its keep. Structure it as a checklist of symptom categories, with follow-up fields for each one the client ticks.

Stress urinary incontinence. Tick if leakage with coughing, sneezing, lifting, exercise. Follow-ups: severity scale 1 to 5 (1 = rare drops, 5 = soaks pad daily); frequency (daily, weekly, monthly); pad use (none, panty-liner daily, pad daily, multiple pads).

Urgency / overactive bladder. Tick if sudden urge to urinate that is hard to defer. Follow-ups: frequency (daily, weekly, monthly); episodes of incontinence with urgency (yes / no); nighttime urination frequency.

Bowel symptoms. Tick if any of the following: chronic constipation, faecal urgency, faecal incontinence, painful bowel movements. Follow-ups specific to each.

Pelvic organ prolapse. Tick if you've been diagnosed with prolapse, or if you experience symptoms suggestive (heaviness, dragging, something coming down). Follow-ups: which type if known (cystocele, rectocele, uterine, vault); POP-Q grade if known; how diagnosed (self-suspected, GP, urogynaecologist, pelvic floor PT).

Pelvic pain. Tick if you have ongoing pelvic pain. Follow-ups: location (vulvar, vaginal, deep pelvic, coccyx, suprapubic); duration; severity scale; associated factors (movement, posture, intercourse, menstruation, urination, defecation).

Sexual function symptoms. Tick if you want to discuss sexual function as part of your session. Optional. Follow-ups: dyspareunia (painful intercourse), reduced sensation, vaginismus history, post-childbirth changes.

The pattern is the same throughout: client ticks the broad category, follow-up fields surface for that category. The client with stress incontinence and nothing else sees three follow-up fields. The client with stress incontinence, prolapse history, and pelvic pain sees fifteen.

Section 4: Pregnancy and postnatal status

Conditional on the client's own indication.

Currently pregnant? Yes / no. If yes: weeks gestational, expected due date, any complications.

Postnatal? Yes / no. If yes: most recent birth date, weeks postpartum, birth type (vaginal / instrumental / c-section), perineal repair (none / first-degree / second / third / fourth), breastfeeding status.

Pregnancy history. Number of pregnancies, number of live births, any pregnancy losses (optional). This last one is sensitive; mark optional and treat any answer with care.

Section 5: Surgical and medical history

Surgical history. Free-form list with date columns. Surfaces only if the client answers yes to "have you had any surgery, particularly gynaecological or abdominal?" Common entries: c-section, hysterectomy, prolapse repair, bladder repair (TVT, TOT), perineal repair, abdominal surgery for other reasons.

Current medications. Free-text field. The clinically-relevant ones for pelvic floor work tend to be anticholinergics (for overactive bladder), oestrogen (for genitourinary syndrome of menopause), anti-spasmodics, and pain management. You will rarely need the full medication list, but having it accessible matters.

Other medical conditions. Conditional on a "any chronic conditions?" prompt. Conditions worth surfacing if present: connective tissue disorders (hypermobility, Ehlers-Danlos), neurological conditions affecting bladder or bowel, recent or active cancers, endometriosis, interstitial cystitis, fibromyalgia.

Section 6: Sexual health

This is the section most generic intake builders handle badly. The right approach: optional throughout, conditional on the client's willingness to engage.

Start with a single prompt: "Sexual health is sometimes relevant to pelvic floor work. Would you like to share anything in this section?" Yes / no / prefer not to say.

If yes, surface a small set of optional fields: relationship status (sexually active / not / prefer not to say), any concerns or symptoms (free text, optional), any history of trauma you want noted (optional, with a short note that any disclosed history is confidential and informs care planning).

If no or prefer not to say, the section closes. The form moves on. You do not get a record of "client declined sexual health questions" because the framing was "would you like to share". The client retains agency.

Section 7: Consent and waiver

The e-signature section. Three things:

Consent to hands-on assessment. Pelvic floor work often involves internal assessment (vaginal or rectal) depending on the practitioner's scope and the client's symptoms. The consent should be explicit: "I consent to internal examination as appropriate to my care plan, and understand I can decline or stop any examination at any time." E-signature required.

Waiver of liability for inherent exercise risk. Standard language acknowledging that physical exercise carries inherent risks. E-signature required.

Data handling acknowledgement. Specify what data you hold, where it is stored, who has access, and the client's GDPR rights (if UK or EU) or equivalent. E-signature required.

Re-attestation at 12 months

The intake form should re-prompt after 12 months. Pregnancies happen, surgeries happen, symptoms change. Re-attestation takes the client 2 minutes (most fields are pre-filled from the prior submission; they confirm or update). A booking system that surfaces the re-attestation prompt automatically saves you the awkward "can you fill out the form again" email.

How to keep client dignity intact

Two patterns matter:

Operator-view collapse. Mark sensitive sections so they are collapsed by default in your client-profile view in the booking system. You expand them only when you intend to read them. This is the difference between sensitive data being part of the record and sensitive data being constantly on display in your dashboard.

Optional within sections. Mark individual fields as optional, especially in the sexual health section. The client retains the choice of what to share. A pelvic floor intake that requires every field is a form most clients will not complete.

The booking-software part

A good intake form lives or dies on the booking system that surfaces it. The capabilities that matter for pelvic floor intake specifically:

• Conditional logic (so the form is short for the average client and complete for the clients who need it).
• Required-before-booking enforcement (the first session is not booked until intake is complete).
• E-signature support.
• Sensitive-section collapse in the operator view.
• Re-attestation prompt automation at 12 months.
• GDPR-grade data handling.
• Free CSV export for client right-of-access requests.

Junocal Starter at $39/month covers all of these. The full operational case for cash-pay pelvic floor specialists lives on Junocal for pelvic floor specialists. 14-day free trial, no card; pricing details on /pricing.

Generic appointment apps (Calendly, Acuity Starter) do not handle conditional logic at all. Acuity Standard handles flat forms but not conditional. Jane App and SimplePractice handle this well but charge for clinical infrastructure (SOAP notes, insurance billing, telehealth) you may not use. The honest match for the cash-pay pelvic floor specialist running a solo practice is a booking system tuned for the workflow without the EHR overhead.