Am I Pregnant Questionnaire

June 14, 2011

Am I pregnant questionnaires are drafted for the help of ladies to understand their state of pregnancy. Such questionnaire consists of questions through which a lady can get an idea if she is pregnant or not. General pregnancy symptoms, current physical status and other factors play a major role in such type of questionnaires.

Sample Am I Pregnant Questionnaire:

Name: __________________

Age: _________________ blood group: ________________

E-mail id: ________________

Q1: Are you aware about the pregnancy symptoms?

  • Yes
  • No

Q2: Can you feel the tenderness in your breast or some pain in both breasts?

  • Yes
  • No

Q3: Are you experiencing any kind of morning sickness and having a feel of nausea?

  • Yes
  • Sometimes
  • No

Q4: Do you go for vomiting after feeling nausea?

  • Yes
  • Yes. Sometimes
  • No

Q5: Have you been experiencing body pain after vomiting?

  • Yes. Many times
  • Sometimes
  • No

Q6: Sometimes, do you feel like having any special kind of food, or you suddenly develop a particular taste in your mouth?

  • Yes.
  • No

Q7: Have you missed your menstruation cycle this month?

  • Yes
  • No
  • Not sure

Q7: Do you feel tired very often these days?

  • Yes
  • No
  • At times

Q8: Are you experiencing mood swings and achy legs?

  • Yes
  • No

Q9: Have you done any type of pregnancy test at home

  • Yes
  • No

Q10. Have you got your blood test done for pregnancy?

  • Yes
  • No

Download Am I Pregnant Questionnaire in Word Format

Top Sample Questionnaire:

Leave a Comment

Previous post:

Next post: