Choose up to 5 concerns so your Legacy provider can prepare for your appointment.

You’re not alone — and you’re not oversharing.
Many patients hesitate to talk about intimate or pelvic health concerns, even though they’re common and treatable. This form helps your provider understand what you’re experiencing so we can have a thoughtful, respectful conversation focused on your comfort, health, and goals. Everything you share is private and handled with care.

Full Name *

Date of birth *

Contact Information *

Email *

City

Postal Code *

Serving Boise, Meridian, and Eagle