Free printable PDF
Pelvic Pain Flare Record, free printable
This pelvic pain flare record gives each flare a structured place to land. It captures when symptoms started, how long they lasted, where pain or pressure showed up, and what was different in the days before the flare began.
Updated May 2026. By Intero.
What is on the form.
01Date, start time, and duration fields
02Pain location notes
03Intensity scale from 0 to 10
04Recent context: sleep, food, stress, activity, cycle, medication
05What helped and what did not help
Make the pattern easier to see.
- 01Fill in the record 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 records 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 context before harder days. The lookback section makes that context easier to record without assuming a cause.
- Is the form really free?
- Yes. The PDF is free to download.
Download the PDF, or keep tracking in Intero.
The worksheet is free. The Intero app gives you a private place to keep tracking on iPhone and review patterns over time.
Sources used
These sources informed the structure and language of this tracking worksheet. The form is informational and does not replace medical advice.