Online Pregnancy Questionnaire
An online pregnancy questionnaire is the most convenient way to understand and evaluate the pregnancy status. One can fill such a questionnaire by visiting an online website and the questionnaire is based on the initial pregnancy conditions, symptoms, current physical changes and other such details.
Sample Online Pregnancy Questionnaire:
Name of the participant: _________________
Date of birth: ____/____/_____, Age: _______
E-mail Address: _______________________
Q1: Are you fully aware about the pregnancy symptoms and its initial tests?
- Not fully aware
Q2: What was the last date of your periods?
Q3: Did you try to check or consult with the doctor regarding your pregnancy doubts?
Q4: Which of the following symptoms you are feeling?
- Tenderness in beasts
- Morning bed sickness
- Vomiting sensation
- Body ache after nausea
Q5: Which of the above given pregnancy symptoms you are encountering the most?
Q6: Did you get any recent bleeding or spotting after missing your periods along with facing the above mentioned symptoms?
- Yes. A little spotting
- Not at all
Q7: Are you taking some kind of medicines or homemade remedy to control any of the above given symptoms?
- If yes, provide the name of the medicines: _______________________
Q8: Are you prone to some allergies?
- If Yes, give details _____________
Q9: Have you conceived before?
Q10. If answer to the above question is yes, how many children do you have at present?
Q11: Is this pregnancy planned?
Category: Health Questionnaire