Pre- Exam Forms

Do any of you play docs require your patients to fill out pre-exam forms? If so, what do you ask? Could you post your forms online?

Yes! I have a form that I have used for awhile. I would send it to you but I would prefer not to post it as it was not mine originally. I was given permission to use it a number of years ago by another play doc. So it really is not mine to post! Email me if you would like to see it and I will send it to you.

I also use a pre-exam questionnaire for my patients. It has several sections, starting with a basic patient physical description, sexual history, exam history including questions about her prior experience at the gynecologist office, sexual practices, and then a check-off list of procedures that she authorizes me to perform. I have had only one patient who declined to fill it out in the last 6 years, and most patients actually find it quite a turn on to fill out.

Pre-exam questionaire here too.

I have a detailed history, exam checklist and consent forms that I use, which also did not originate with me, so I cannot post them. I would be happy to describe them if you catch me in chat, or send me a PM.

You can google "physical examination questionnaire" or "gynecological examination questionnaire" or "Woman's Health History" or "Patient's History Form" and you will find more forms that you know what to do with.

I love filling these out- the idea really turns me on.

Medfetcouple is correct but they are not as erotic as what I have. So again a private message and I will consider sending mine especially if you will consider filling it out for me just so I can collect the filled out forms and compare responses!

Here's a link to the form Dr. Wellhung uses:

http://www3.xfreehosting.com/fetish/drwellhung/medhist.html

It looks pretty comprehensive for a play exam situation.

WOW, 😮 That is a COMPLETE form. 😁 Exactly the type of healthcare needed today, instead of the Drive-thru docs.

That's funny! I did not get it from there but it is the same as what I have! I wonder who had it first Dr Wellhung or my source!

Just looking at that sheet turns me on

How wonderful the two of you can share this together ! I'm so jealous and would love to see those videos. Can you " edit " them to blur faces in order to share.

Respectfully,

Del From Michigan

I do have one, in Czech unfortunatelly. If any1 is interested, Ill post it. Anyway, I do not think id differs from US version much.

Yes I do use a medical history questionaire with my patients, it's in portuguese, it's very complete it's in portugusese

http://latina.obgyn.net/portugues/PDF/FICHA%20CL%CDNICA%20DA%20MULHER.pdf

latina.obgyn.net/portugues/PDF/FICHA%20CL%CDNICA%20DA%20MULHER.pdf -

Filling these out is a HUGE turn-on for me. Invasiveness before the invasiveness begins... it's delicious.

Thank You for posting your answers online to the form. That was great and I would love to have you for a patient!

Hello Suppersally,

Thank you for providing your Medical History / Consent to Treatment Form. I've had many patients submit these but you are the first to post yours online. Excellent! Your information indicates that you have a most positive patient attitude and are quite experienced. If you're ever in the SE Michigan area let me know. You definitely qualify for a complete complimentary exam! And I am 99% sure I can take care of giving you that missing cervical orgasm experience too.

Warm Regards,

Dr. Wellhung

You sound a very good and experienced patient supersally. I don't use forms myself, however I take a thorough and detailed history of my patients

I like the idea of the forms, but I also like speaking it directly to the doctor. Seems like it would be more embarrassing...and arousing for the same reasons.

Flyfisher, first the exam is filled out by the patient. then it is reviewed by the doc. Then, either before the appt, or face to face just before the exam, that's when the very direct, probing discussion takes place. 😁

[quote author=rich52us link=topic=18968.msg211376#msg211376 date=1242765398]

Flyfisher, first the exam is filled out by the patient. then it is reviewed by the doc. Then, either before the appt, or face to face just before the exam, that's when the very direct, probing discussion takes place. 😁

[/quote]

Very nice. A combination of pre exam forms and questions and double the anticipatory excitement.

I like the idea of the pre-examination forms. Filling out the forms and then sitting face to face with the doctor and answering the questions is such a turn on. I find the questions exciting and embarrassing, especially when it is a new new doctor. The questions can be so intimate, and highten my arousal at the same time. Thanks for posting your pre-examination forms Dr. Wellhung, amaral, and suppersally, I really enjoyed reading them.

Can we see some more examples of forms that people have made?

I have a full exam form I created for my male strippers to have fully completed! It has a questionair, and actual physical check list for the doctor to complete!

Nice form here - thanks! One can easily modify it for when a male is the patient. I made up a small form once that she filled out. It had a small area to write in her own fanatasies (briefly, of course). I think it's a great way to start and adds to the fun.

Oops - forgot to mention that I would also add in a spot to consent for injections/'immunizations' for those of us who like to play with sharp objects 😉

Starting with typical questions that move into erotic questions is great....start with age, height, weight, then move to measurements...breast size, penis size, waist measurements, hip measurements....then move to history questions such as first time for erection, first time for ejaculation....or first orgasm....then move to first time for intercourse, oral, anal, etc.

I too use a pre-exam form, however it is not as long as the one posted!

PHYSICAL DETAILS

Height: (5)feet (4)inches

Build: ( )slim (x)average ( )voluptous ( )bbw

Measurements: (41)breast (25)waist (37)hips

Brassire Cup Size: ( )A ( )B ( )C ( )D (x)DD

Pubic Hair: ( )full ( )trimmed (x)shaved

GYNECOLOGICAL HISTORY AND DETAILS

Have you given birth? (x)yes ( )no

If yes, was it vaginally? (x)yes ( )no

Have you had a tubal ligation? ( )yes (x)no

Have you had a hysterectomy? ( )yes (x)no

Do you use contraceptives? (x)yes ( )no

Do you have regular menstruation? (x)yes ( )no

Do you douche? (x)yes ( )no

Date of last pelvic exam? (6)month ( )year

Practitioner: (x)male ( )female

Manual Breast Exam? (x)yes ( )no

Manual Internal Vaginal Exam? (x)yes ( )no

Vaginal Speculum Exam? (x)yes ( )no

Manual Recto-vaginal Exam? (x)yes ( )no

Rectal Speculum Exam? ( )yes (x)no

Did you experience sexual arousal? (x)yes ( )no

Did you masturbate following Exam? (x)yes ( )no

Do you do breast self-exam regularly? (x)yes ( )no

Do your nipples erect spontaneously? (x)yes ( )no

Do you experience nipple secretions? (x)yes ( )no

Does your clitoris erect spontaneously? (x)yes ( )no

Does your vagina lubricate spontaneously? (x)yes ( )no

SEXUAL HISTORY AND ACTIVITY

Age of first masturbation: 13 How long since most recent? 3 days

Age of first orgasm: 13 How long since most recent? 3 days

Age of first receiving oral: 14 How long since most recent? 4 days

Age of first performing oral: 14 How long since most recent? 4 days

Age of first vaginal intercourse: 15 How long since most recent? 4 days

Age of first anal intercourse: 18 How long since most recent?

SEXUAL EXPERIENCES AND RESPONSES

Do you have any bi-sexual tendencies? ( )yes (x)no

If yes, have you had a female partner? ( )yes (x)no

Do you have submissive tendancies? (x)yes ( )no

Have you ever had a medplay experience? (x)yes ( )no

Have you ever been fisted? ( )yes (x)no

Have you ever been given an enema under erotic circumstances? ( )yes (x)no

Have you ever had a DP [double penetration]? (x)yes ( )no

If yes, please select all that apply (x)vaginal and anal ( )double vaginal ( )double anal

Have you ever explored urethral stimulation [peehole play]? ( )yes (x)no

Do you often experience multiple orgasms? (x)yes ( )no

Do you squirt (female ejacualtion)? ( )yes (x)no

Have you ever experienced a vaginal orgasm? (x )yes ( )no

Have you ever experienced a clitoral orgasm? (x)yes ( )no

Have you ever experienced a g-spot orgasm? (x)yes ( )no

Have you ever experienced a urethral orgasm? ( )yes (x)no

Have you ever experienced an anal orgasm? ( )yes (x)no

Have you ever experienced a cervical orgasm? ( )yes (x)no

Have you ever experienced a nipple orgasm? ( )yes (x)no

Do you masturbate? ( )yes ( )no

If yes, how often? ( )daily (x)weekly ( )monthly

Have you ever used a vibrator? (x)vaginally ( )anally ( )no

Have you ever used a dildo? (x)vaginally ( )anally ( )no

Have you ever used a shower massage? (x)vaginally ( )anally ( )no

Have you ever used a vibrating egg? (x)vaginally ( )anally ( )no

Have you inserted fruits/veggies? (x)vaginally ( )anally ( )no

Have you inserted a bottle? (x)vaginally ( )anally ( )no

Have you inserted a hairbrush? (x)vaginally ( )anally ( )no

Have you inserted other objects? (x)vaginally ( )anally ( )no

If yes, list all objects and where:

YOUR EXAMINATION

Your examination will be exceedingly thorough and complete.

In addition to the typical procedures, there are specialized

procedures recommended to ascertain the sexual health, function,

and responsiveness of the patient. Some of these procedures

might cause the patient to feel embarassed or otherwise be

reluctant to undergo them. In this case, the patient has the

option to decline to authorize the procedure(s). Of course,

should any procedure(s) not be authorized, the doctor's

evaluation of the patient's sexual health, function, and

responsiveness may be incomplete in the related area.

Additionally, should the patient feel that she may have any

difficulty maintaining the prerequisite degree of cooperation

during the authorized procedures, then restraints may be advisable.

CONSENT TO TREATMENT

Please review the list of typical and specialized procedures

and select those that you authorize, pursuant to the advisory

statement above.

Therapeutic Massage? (x)authorized

Examination While Restrained? (x)authorized

Manual Breast Exam? (x)authorized

Nipple Oral Responsitivity? (x)authorized

Nipple Suction Pump Responsitivity? (x)authorized

Vaginal Douche Prior to Exam? (x)authorized

Manual G-spot Responsivitity? (x)authorized

Manual Deep Internal Vaginal Exam? (x)authorized

Vaginal Speculum Visual Exam? (x)authorized

Vaginal Dilation Capability Evaluation? (x)authorized

Vaginal Vibratory Responsitivity? (x)authorized

Vaginal Oral Responsitivity? (x)authorized

Observed Urine Specimen? ( )authorized

Enema Prior to Rectal Exam? ( )authorized

Rectal Temperature? ( )authorized

Manual Recto-vaginal Exam? ( )authorized

Rectal Speculum Exam? ( )authorized

Rectal Probe Exam? ( )authorized

Clitoral Oral Responsitivity? (x)authorized

Clitoral Vibratory Responsitivity? (xxauthorized

Clitoral Suction Pump Responsitivity? (x)authorized

TENS (electrostimulation) therapy? ( )authorized

Urethral Sounds Dilation Capability? ( )authorized

Ejaculatory Fluid Catheter Specimen? ( )authorized

Oral Penile Capacity Evaluation? ( )authorized

Vaginal Penile Capacity Evaluation? (x)authorized

Rectal Penile Capacity Evaluation? ( )authorized