Am I Pregnant Questionnaire

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