Initial consultation note: Free sexology form template

Key takeaways

The template on this page is a sexology initial consultation note, written for first assessments in sexual health, men’s health, and andrology.

It runs from presenting sexual symptoms through medical, drug, fertility, and relationship history to impression, diagnosis, and next action.

Three validated scores have their own prompts: the AMS scale, the Epworth Sleepiness Scale, and the IIEF-15.

The note has no demographics header, no consent declaration, and no signature block, so pair it with your own registration and consent forms.

Building the note into practice management software like Pabau sends it out before the appointment and files answers into the patient record.

The initial consultation note you can download above is specialty-specific. It is a sexology consultation form, built for the first appointment in a sexual health, men’s health, or andrology practice. Every prompt on it does the same job. It gets a full sexual, hormonal, and fertility picture down on paper in one sitting.

That focus is also its limit. The note starts at the date and goes straight into presenting issues, so it assumes your registration and consent paperwork is already done. If you need a general aesthetic intake instead, use our med spa consultation form.

What is a sexology initial consultation note?

A sexology initial consultation note is the clinical record of a patient’s first sexual health assessment. It documents the presenting sexual symptoms and the medical and drug history behind them. It also holds relationship and fertility context, validated symptom scores, and the clinician’s impression and plan.

It differs from a general intake form in two ways. First, the history it asks for is hormonal and sexual rather than procedural. Second, it builds in scoring instruments, so a subjective complaint leaves the room as a number you can compare later.

Who this form is for

The prompts suit any clinician who assesses sexual function, male hormones, or fertility. In practice that means sexual health practices and men’s health services, with andrology and fertility teams close behind.

• Sexual health and sexual medicine practices: The presenting issues, sex and relationships, and IIEF-15 prompts cover a first erectile or libido consultation.
• Men’s health and testosterone replacement practices: The drug history, testosterone deficiency medication, AMS score, and HCG prompts map onto a testosterone workup.
• Andrology and urology services: The semen analysis prompt and surgical history fields support a male factor assessment.
• Fertility services: The fertility block asks about both past attempts and future plans, which shapes treatment choice from the first visit.

Aesthetic injectors, dermatologists, and talking therapists will find little of use here. Their intake needs demographics, contraindication screening, and treatment consent, and none of those sit on this form.

What the form covers, section by section

The template moves in one direction, from symptom to history to score to plan. Here is every section on it, in the order you will meet it.

Two labels are worth translating before you hand the form to a colleague. TD related medications means anything the patient takes for testosterone deficiency, including gels, injections, and HCG. HCG stands for human chorionic gonadotropin, which is often considered where fertility matters.

What this template does not cover

Four things you might expect on an intake form are absent by design, and each one needs a document of its own.

• No demographics block. There is no name, date of birth, contact, or emergency contact field. Your patient registration record has to carry those, and the note has to be filed against it.
• No consent declaration. The form holds no treatment consent, photography consent, or privacy notice. Capture those separately with a HIPAA compliant consent form before treatment starts.
• No signature block. Neither the patient nor the clinician signs this page. Add your own sign off line if your governance policy requires a signed note.
• No contraindication checklist. Eligibility is left to your judgment in the impression field. Practices running testosterone therapy usually add a screening list for prostate history, hematocrit, and cardiovascular risk.

That keeps it a clinical note rather than a full intake pack. Slot it into the wider set of medical forms your practice already runs, and it works best as the second document a new patient touches.

How the three scores work

The three score lines are the reason to use this note over a plain history sheet. Each one is a published questionnaire the patient completes. The form only asks you to record the total.

• AMS score. The Aging Males’ Symptoms scale has 17 items rated one to five, giving a total between 17 and 85. Higher totals point to more severe symptoms, and the commonly used bands run from little or no symptoms to severe.
• ESS score. The Epworth Sleepiness Scale has eight items scored zero to three, for a total out of 24. A score above 10 suggests excessive daytime sleepiness, which is worth chasing because sleep apnea and low testosterone often travel together. Where the complaint is insomnia rather than sleepiness, the Insomnia Severity Index is the better instrument.
• IIEF-15 score. The International Index of Erectile Function has 15 items across five domains. Most practices record the erectile function domain, scored out of 30, where lower numbers indicate more severe dysfunction.

Follow your own protocol for the cutoffs you act on, and write the version you used next to the number. A score with no scale named is hard to interpret a year later. It is harder still for a colleague picking up the case.

Why a structured sexual health history matters

Sexual health histories are easy to record unevenly. One clinician asks about fertility plans and another does not, so the second visit starts from a weaker position than the first.

• Faster consultations: Patients who complete the history and score sections before arrival free up most of the appointment for examination and discussion.
• Comparable follow-ups: Recorded AMS, ESS, and IIEF-15 totals let you show whether treatment moved the symptom, rather than relying on recall.
• Defensible records: A consistent note documents why you chose a treatment, and why HCG or semen analysis was or was not recommended.
• Better patient experience: A structured form signals that sensitive questions are routine here. Capturing patient feedback on how the intake felt will tell you whether the wording lands.

How to run the consultation

Work down the form in order. It is sequenced so the sensitive questions arrive after the routine medical ones.

1. Open with the presenting issue: Ask what brought the patient in and how the symptom shows up. Record onset and whether it is constant or intermittent.
2. Take the medical and drug history: Cover past conditions, surgery, allergies, and every current medication. Note anything already prescribed for testosterone deficiency.
3. Move into sexual and relationship history: Ask about the sexual history and the relationship context. Then cover past fertility attempts and future plans.
4. Examine as indicated: A genitourinary physical exam is standard in a first andrology or erectile assessment. Record the findings before you move on to the numbers.
5. Collect the scores and measurements: Record the AMS, ESS, and IIEF-15 totals that apply. Add height, weight, BMI, blood pressure, and waist circumference, plus any blood results. A body composition test adds detail where weight alone hides muscle loss.
6. Close with impression and plan: Write your impression and diagnosis, agree the next action and preferred treatment, and answer the HCG and semen analysis prompts.

Write the diagnosis in a form you can code later. Testicular dysfunction with no cause established often codes to E29.9, which saves a second read of the note at billing.

Questions to ask at the first appointment

These questions fill the free text sections of the form without turning the appointment into an interrogation. Each one maps to a field on the note.

• “What brings you in today, and how do the symptoms show up for you?” (presenting issues)
• “When did you first notice the change, and has it been there every time since?” (symptom timeline)
• “Which medications are you taking, including anything prescribed for testosterone?” (drug history and TD medications)
• “Do you have any allergies to drugs, foods, or topical products?” (allergies)
• “Have you had any surgery, particularly to the abdomen, pelvis, or testes?” (past surgical history)
• “Does anyone in your family have diabetes, heart disease, or a hormone condition?” (family history)
• “How are your mood, stress levels, and sleep at the moment?” (mental and emotional health, and a lead into the ESS)
• “Are you in a relationship, and how are these symptoms affecting it?” (sex and relationships)
• “Have you tried to conceive before, and do you want children in the future?” (fertility, past and future)
• “How much alcohol do you drink, do you smoke, and how active is a typical week?” (social history)
• “What would a good outcome look like for you in six months?” (preferred treatment choice)

Initial consultation checklist for clinicians

Use this checklist around the note so nothing is missed before, during, or after the appointment.

• Before the appointment: Send the history and score questionnaires ahead of the visit through your appointment reminders. Book 45 to 60 minutes and review any referral letter.
• At check-in: Confirm registration details are on file and your consent form is signed. Check the returned questionnaires for blank score sections.
• During the consultation: Work down the note in order, examine as indicated, and record measurements. Say out loud that the sexual history questions are routine.
• Before the patient leaves: Agree the next action and treatment choice. Order bloods, and settle the HCG and semen analysis questions rather than deferring them.
• After the appointment: File the note in the patient’s medical record within 24 hours. Send the plan to the patient portal and book the follow-up.
• At follow-up: Repeat the scores that applied at baseline. Compare the totals side by side, and file the review as a SOAP progress note.

How to digitize your consultation notes with Pabau

A printed sexology note has to be carried, filed, and found again. Sensitive answers sit in a cabinet, and last year’s AMS or IIEF-15 total is only comparable if someone digs the paper out.

Practice management software like Pabau lets you rebuild this note as a digital consultation form. Conditional logic hides the fertility and HCG questions unless they apply, so the patient only sees what is relevant to them.

The form goes out by email or SMS ahead of the appointment, and the answers land in the patient’s record before they arrive. Because the score fields are structured, you can pull last visit’s AMS or IIEF-15 total onto the screen next to today’s.

Consent forms sit alongside the note in the same patient record, so the paper version’s split filing disappears. Esteem Life Medical Group runs a digital-first practice this way, with records, forms, and charting in one system.

Every completion and edit is timestamped and attributed. That gives you an audit trail for a sensitive record. A clinician covering the case can see exactly what was asked, and when.

Move your consultation notes off paper

Pabau turns your sexology consultation note into a digital form that patients complete before arrival. Scores, history, and consent are filed in one patient record. Your team spends the appointment assessing instead of transcribing.

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Conclusion

Download the note, read it against your own pathway, and decide what you need to bolt on. For most practices that means a registration record in front of it and a consent form beside it. In exchange you get a first appointment that ends with a number, a diagnosis, and a decision.

The scores are the part worth protecting. Record them at baseline and repeat them at review. The second visit then opens with evidence rather than recall, so you can see whether the treatment helped. Book a demo to see how Pabau collects consultation notes, scores, and consent in one patient record.

Continue your research

Need a scored measure of sexual orientation? The Kinsey scale template shows how the scale is scored and where it fits in a sexual history.

Seeing patients about fertility? Our infertility consultation notes template covers the workup that follows a positive fertility flag on this form.

Checking hormones alongside symptoms? The male estrogen levels template gives you reference ranges to read next to a testosterone result.

Need the examination detail? Our guide to the cremasteric reflex covers how to elicit it and what an absent response means.

Is body image part of the presentation? The Objectified Body Consciousness Scale gives you a scored way to record it.

Frequently asked questions