Antenatal Booking visit forms


A first-ever visit made by a woman to her doctor after conception is commonly known as “booking visit”. A detailed introduction is made as well as the pregnancy is tracked well in time which can spare a lot of energy, resources and most of all the health of mother and child has a better outcome.

Ideal time

It should be done as soon as she discovers she is pregnant. Ideally around 6 to 8 weeks of her gestation when an initial examination and investigations including a dating scan can be done.

Components of the form

They are divided into different sections.


1. Introduction

  1. Name of the obstetrician/ midwife is written in the top most section for the sake of convenience in her subsequent visits.
  2. Patient’s name, husband’s name, age, address, ethnicity, contact or any other relevant information.

2. Dates

  1. Date the exam/checkup.
  2. Date of her last menstrual period commonly abbreviated as LMP. This is very important because her expected date of delivery and gestational age is calculated from this. Also, the age of her fetus and its development is estimated and correlated with examination and investigation.

3. Previous obstetric history

 This includes

  1. Gravidity which means if this is her first pregnancy or second or whatever, we have to mention it.
  2. Parity includes a number of her alive babies she already has. If this is her first pregnancy, we mention as Zero.
  3. Miscarriages if any are also mentioned in number along with the age at which she miscarried her child is very important.
  4. In the past pregnancies any complications occurred are also mentioned along with the mode of delivery of her child. Either the baby was delivered normally or via C-section or instruments.
    1. General condition of the babies born is mentioned, their sex, weight at birth and any congenital anomalies if present are also asked and mentioned.

4. Gynecological history

Gynecological history is very significant whether a woman is pregnant or not. Main questions we need to ask her are,

  1. Nature, duration and time of her menstrual cycle
  2. Any modes of contraception used by her
  3. If her pap smear was done or not. It is important because pap smear is done to diagnose various infectious and non-infectious diseases including cervical carcinoma
  4. Any other gynecological issue she faced in the past

5. Medical and surgical history

  1. Generally, we ask if she suffered from diabetes, hypertension, cancer, liver or lung disease other than pregnancy in the past or underwent any surgery for any reason.
  2.  Blood group and hepatitis B and C status is mentioned 
  3. Any history of transfusion or its components
  4. We always ask is she any allergies to any drug, food, season or anything she wants to mention. This is very important because we do have to administer various drugs when needed and we must have a proper knowledge of everything about patients.
  5. If she is currently taking any medicines or not

6. Follow up instructions

In the end we have to give her instructions for home, which medicines to take, what precautions she needs in the future and when to come again for her next visit or any investigations if needed.

Antenatal booking visit form
Antenatal booking visit form PDF

Simi Karton

Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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