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Pelvic Pain Flare Record, free printable
Use this pelvic pain flare form to write down when a flare started, how long it lasted, where pain or pressure showed up, and what was different in the days before it began.
Updated May 2026. By Intero.
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What is on the form
- Date, start time, and duration fields
- Pain location notes
- Intensity scale from 0 to 10
- Recent context: sleep, food, stress, activity, cycle, medication
- What helped and what did not help
How to use it
- 01Fill in the form as soon as you reasonably can after a flare begins.
- 02Use the recent-context section for concrete details, not broad categories.
- 03If a flare lasts more than one day, use one row for the flare rather than one row per day.
- 04Bring a few recent flare forms to an appointment if you want to discuss patterns.
Common questions
- What counts as a flare?
- Use your own consistent definition. A practical starting point is a day or stretch that stands out from your recent baseline.
- Why include the days before the flare?
- Some people notice useful details before symptoms get worse. The lookback section gives you a place to write them down without assuming a cause.
- Is the form really free?
- Yes. The PDF is free to download.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.