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Reproductive Health Visit Prep Kit

A plain visit prep kit for reproductive health appointments, organized by visit type: general doctor visits, phone and telehealth calls, teen and first period visits, IUD checks, perimenopause, focus and mood, medicine questions, and insurance paper trails.

A reproductive health visit can cover a lot of ground fast.

This page holds short worksheets for many visit types. Pick the one that fits. Use more than one if your visit covers more than one topic.

None of these worksheets diagnose a cause. None tell you what care to choose. Ask a clinician or pharmacist about medical questions.

If symptoms feel urgent, severe, sudden, or unsafe, seek care now.

Pick your visit type

Visit type Jump to General doctor visit, any period concern General visit prep Phone call to a clinic Clinic phone call script Telehealth or video visit Telehealth visit script First period, teen visit First period questions Teen period symptoms visit Teen symptoms sheet School nurse visit School nurse card IUD insertion or follow up IUD checklist Perimenopause Perimenopause checklist Heavy or long bleeding Period won't stop prep Abnormal Pap result Abnormal Pap questions Product change symptoms Product change summary Ovulation calculator results Ovulation calculator questions Focus, memory, or mood changes Cycle and focus summary Medicines and cycle changes Medication and cycle notes Antibiotics and cycle changes Antibiotics and cycle notes Insurance, EOBs, and records Insurance paper trail map

General visit prep

Use this for any period related doctor visit. Fill out the one page note first.

Prompt Your note Main reason for the visit What changed When it started Last period start date Usual cycle length, if known Current bleeding or symptom Worst day or worst symptom Medicines, vitamins, or supplements to mention Tests or visits already done Main question today What you want next

Symptom timeline

Date or week What happened Period timing Daily impact before period, during period, after period, not sure

Daily impact can be plain: missed work, missed school, woke up at night, leaked through clothes, needed to lie down, avoided sex, felt worried, could not focus.

What to bring

Item Bring? Note Short visit note Period dates Symptom log Medicine list Lab names or results Pharmacy or insurance question

Do not bring your full app history by default. Ask what is needed.

During the visit

Topic What the clinician said Follow up Main concern Possible causes to check Tests Symptoms to watch When to call Next visit

Try: "Can you say that in plain words?" or "What should I do next, and when?"

After the visit

Question Your note What did we decide today? What do I need to do next? What symptoms should I track? What should make me call? Who do I contact with questions? What records do I need to save?

MedlinePlus suggests preparing for doctor visits with a list of questions, symptoms, medicines, and health history details. MedlinePlus also explains that personal health records can help track medicines, allergies, tests, and provider details.

Clinic phone call script

Use this to call a clinic about period pain, bleeding, or cycle changes. This is not medical advice. If symptoms feel urgent, seek care now.

Mayo Clinic says to see a health care professional if menstrual cramps disrupt life every month, symptoms get worse, or severe cramps start after age 25.

What to ask

Pick the questions that fit.

Should I book a visit? Should it be phone, video, or in person? How soon should I be seen? What symptoms should make me call back sooner? What notes should I bring? Do you want period dates or a pain diary?

Call notes

Question Answer from clinic Person I spoke with Date and time Next step Visit type What to bring or upload What should make me call back

Telehealth visit script

Use this for a video or phone visit. This is not medical or legal advice.

Step Your note Main reason for the visit Last period start date What changed Worst day What you want help with One privacy question

Telehealth.HHS.gov tells patients to learn what information providers can and cannot share and how personal health information is kept safe during telehealth. It also says not to record a telehealth visit without asking the provider first.

Screen and portal checklist

Item Done I know the visit link or phone number. I have a quiet place if I can get one. I closed private tabs or photos. I have my short note ready. I know whether I plan to upload anything. I will ask before recording.

Ask what the clinic needs before you upload a full export. A one page note, screenshot, or read aloud script may be enough.

First period questions

Use this before a first period visit, a school nurse visit, or a parent call to a clinic. ACOG answers common first period questions, and MedlinePlus explains puberty changes, including periods.

Question My note First day I saw blood Last day I saw blood Flow words light, medium, heavy, or changed by day Worst pain, 0 to 10 Did I miss school or plans? Supplies I used What scared or confused me What I want kept private

MedlinePlus says periods may take time to become regular. ACOG says period patterns can be a health sign, and clinicians should ask about menstrual patterns as part of routine adolescent care.

Ask what to track, what pattern should mean a call to the office, and what can stay out of a chart. Rules on privacy can vary by clinic and place, so ask the office how it works.

Teen symptoms sheet

Use this before a doctor visit about a teen's period. You do not need perfect notes.

Question Your notes First day of your last period How long bleeding lasted Usual cycle length, if known Any chance of pregnancy Current medicine or birth control What you most want help with

Bleeding notes

Check Your notes Pads, tampons, cups, or period underwear used each day Times you leaked through clothes or bedding Clots, if any Bleeding longer than 7 days Feeling dizzy, weak, or faint Nosebleeds, easy bruising, or bleeding after dental work

ACOG says heavy menstrual bleeding in adolescents can be an important sign to evaluate and may be linked to bleeding disorders. If you feel weak, faint, or very unwell, ask for help now.

You can ask to talk with the doctor alone for part of the visit. Rules can vary, so ask before you share anything sensitive.

School nurse card

Use this before or during a school nurse visit. It is not medical advice or school policy advice.

text School nurse period visit card

I need help with: supplies cramps leak spare clothes call home other:

Pain score, 0 to 10: Bleeding concern: Symptoms: What I want kept private: Main question:

CDC says schools can build time for handwashing into the day, especially after bathroom breaks. MedlinePlus lists period symptoms like cramps, lower back pain, bloating, headaches, fatigue, and mood changes.

Mayo Clinic says to see a health care provider if cramps disrupt life every month, get worse, or severe cramps start after age 25.

Keep notes small. Screenshots, shared phones, and messages can be seen outside an app.

IUD checklist

Use this for an IUD insertion follow up, or if bleeding or cramps start after months or years.

Concern Check I have bleeding after insertion. I have cramps after insertion. Bleeding started after months or years. Cramps started after months or years. I have a strings question. I want to know when to call.

Ask what to document

What dates should I write down? Should I track spotting and full bleeding, flow level, and pain score? Should I note fever, odor, or discharge changes? Should I track strings notes? If yes, how?

CDC Selected Practice Recommendations discuss bleeding irregularities during IUD use and clinical evaluation when indicated. ACOG explains IUD basics and the role of clinician follow up for problems.

Ask when to call

Question Clinician answer What symptoms mean I should call? What symptoms mean urgent care? What if I may be pregnant? Who do I call after hours?

Use this summary format: "My IUD was placed on . My bleeding or cramps started on . It happens . The heaviest day was . My worst pain was out of 10."

Perimenopause checklist

Use this before a perimenopause visit. Contact a clinician now if bleeding is very heavy, or if you feel faint, have severe pain, or may be pregnant.

Field Your notes Main reason for the visit Age Last period start date Current cycle range Biggest bleeding change Biggest body symptom Biggest mood or sleep change Current birth control or hormones Main goal for the visit

Symptom notes

Symptom How often? How bad? Hot flashes Mild / medium / strong Night sweats Mild / medium / strong Broken sleep Mild / medium / strong Mood changes Mild / medium / strong Brain fog Mild / medium / strong Vaginal dryness Mild / medium / strong Pain with sex Mild / medium / strong

ACOG says bleeding changes can happen near menopause, and bleeding after menopause should be checked. Office on Women's Health says menopause care depends on symptoms, health history, and personal choice. ACOG says hormone therapy may help some symptoms, but risks and benefits vary by person.

You do not have to share every symptom. Pick the ones you want help with. Do not stop or change medicine because of this checklist.

Period won't stop prep

Use this when a period will not stop. This sheet does not tell you the cause.

Question Your answer Bleeding start date How many days has it lasted? Is it spotting, light flow, or full flow? Heaviest day Biggest clot size Worst pain score, 0 to 10 Any dizziness, weakness, fatigue, chest pain, or short breath? Any bleeding after sex? Any missed period or pregnancy test? What changed from your normal period?

ACOG describes abnormal uterine bleeding as bleeding unusual in amount, timing, or length, and lists bleeding lasting more than 7 days, soaking products often, and passing large clots as signs of heavy menstrual bleeding. Office on Women's Health says unusual bleeding includes bleeding that differs from a typical period.

If the amount, pain, or symptoms feel sudden, severe, very heavy, or very different for you, ask for care before the log is perfect.

Abnormal Pap questions

Use this to copy result words. Do not use it to explain the result or choose follow up.

Item Your note Test date Exact Pap result words HPV status, if shown positive / negative / not shown Result note from portal Last Pap test date Last HPV test date, if any

CDC explains that a Pap test checks cervical cells and an HPV test checks cells for HPV. NCI explains that abnormal HPV and Pap results need clinician review, with terms like ASC US, LSIL, HSIL, and HPV positive. ACOG explains cervical cancer screening may use a Pap test, an HPV test, or both.

Ask: What are the exact result words? Was an HPV test done too? Do you need my last Pap or HPV date? HHS says people have rights to see and get copies of health records from covered providers.

For result type notes on biopsies, mammograms, or colposcopy, use biopsy, Pap, and mammogram result notes.

Product change summary

Use this if symptoms started after changing pads, liners, tampons, cups, discs, wipes, underwear, or detergent. This page does not name a cause.

Summary item Your note Date symptoms started Product change before symptoms pad / liner / tampon / cup / disc / wipe / underwear / detergent / other Time between change and symptom minutes / hours / days / not sure Main skin symptom itch / burn / raw / rash / swelling / other Discharge or smell changed yes / no / not sure Fever or chills yes / no / not sure

Ask a clinic, nurse line, or urgent care how soon you should be seen if you have fever, feel very sick, or pain is strong or getting worse.

For discharge and odor tracking, use the vaginal discharge and odor checklist.

Ovulation calculator questions

Use this before you trust or share an ovulation calculator result. It is not fertility, birth control, pregnancy, diagnosis, or treatment advice.

Question Your note What period start date did I enter? What cycle length did I enter? What date did it estimate? Will the tool save my data? Will it show labels on a calendar or send reminders?

Office on Women's Health says cycle length can differ from month to month, and the time between ovulation and the next period can vary. That is why calculator results should not be treated as exact.

FTC guidance for mobile health apps includes minimizing data, limiting access and permissions, and using privacy protective default settings.

Cycle and focus summary

Use this to organize focus, memory, and mood notes tied to your cycle. It does not diagnose PMS, PMDD, ADHD, anxiety, depression, or any other condition.

Field Your notes Main focus concern Last period start date Focus got worse on these dates Focus got better on these dates Most affected task Main daily impact Main question for the visit

ACOG lists problems concentrating among possible PMS symptoms. Office on Women's Health lists trouble thinking or focusing among PMDD symptoms and says PMDD can interfere with daily life. NIMH describes ADHD as a developmental disorder with persistent symptoms of inattention, hyperactivity, and impulsivity.

This worksheet cannot tell whether a focus change is PMS, PMDD, ADHD, anxiety, depression, or something else. It only gives your clinician clearer facts.

Medication and cycle notes

Use this to list medicines, vitamins, supplements, timing, and cycle notes. This page does not give medication advice, dosing advice, or tell you to start, stop, or change anything.

Name Why you use it, if known When you take it Question

Cycle timing

Date Cycle timing Symptom Medicine or supplement note before period, during period, after period, not sure

CDC medication safety guidance says people should keep a list of medicines, vitamins, and supplements and ask a pharmacist or doctor if label instructions are unclear. MedlinePlus suggests bringing a medicine list to doctor visits.

Antibiotics and cycle notes

Use this if you took an antibiotic and your cycle changed. It does not give a blanket answer either way and does not give medication advice.

Prompt Your note Antibiotic name, if known Start date Stop date Other medicines used Expected period date Bleeding or spotting change Main clinician or pharmacist question

Office on Women's Health says home pregnancy test timing can affect accuracy, and most medicines, including antibiotics, should not affect home pregnancy test results. NHS says late or missed periods can have many causes.

If bleeding is heavy, sudden, painful, or unsafe, ask for care. Do not wait to finish the worksheet.

Insurance paper trail map

Use this to list where insurance and clinic records may land after reproductive health care. It does not give legal advice and cannot stop a plan from sending a notice.

Insurance item Where it may show Question to ask Claim Plan portal Can I change contact settings? EOB Mail, email, portal Can I get portal only notices? Lab claim Plan portal, EOB Where will results go? Prescription claim Plan portal, pharmacy Can I turn off refill reminders?

HHS explains that the HIPAA Privacy Rule covers certain health plans, providers, clearinghouses, and business associates, and that covered entities may use and share health information for treatment, payment, and health care operations. FTC guidance tells mobile health app developers to limit data collection and be clear about privacy practices.

Do not put portal passwords or claim numbers in a period app. Keep insurance records in a separate, private place.

Privacy note for every visit type

Visit notes can include sex, mood, pregnancy worries, medicine names, clinic names, and location.

Use the smallest note that still helps care. Ask the clinic what details they need before you export, screenshot, or upload a full history.

Floriva note

Floriva can hold short cycle notes on your device. That can help you build the worksheets above.

Floriva cannot control clinic, portal, insurance, lab, pharmacy, screenshot, backup, or shared device records.

For more app privacy help, read the period tracker data minimization guide and Floriva for gynecologist prep.