Sample Pregnancy Questionnaire
Sample pregnancy questionnaires are filled by the women who are pregnant. In such a questionnaire, the knowledge of the participant is being examined by various pregnancy related questions which are based on pregnancy symptoms, general checkups and associated complications.
Sample Pregnancy Questionnaire:
Date of Birth: ________________ Age: ______________ blood group: ________________
Phone Number: ____________________
Email id: _______________________________
Q1: Do you think you have the full knowledge of pregnancy periods and associated benefits?
• Not much
Q2: Is this a planned pregnancy?
Q2: How did you confirmed or checked that you are pregnant?
• Used a pregnancy strip to check
• Consulted a gynaecologist
• Calculated from certain physical symptoms
Q3: How often do you visit your gynaecologist?
• Once in a week once in a month
• Twice in a month
• Once in two months
• Whenever required
• Not visiting a doctor
Q3: Are you taking any prescribed pills and salts?
Q4: How frequent are you feeling nausea, giddiness and other expected symptoms?
Q5. How are you controlling above mentioned symptoms of your pregnancy?
• Taking prescribed pills
• Using homemade remedies
• Not taking anything
Q6: Do you feel uncomfortable after taking certain medicines?
Q7: Are you feeling some kind of weakness during the pregnancy?
Q8. Is there any other query which you would like to clarify regarding pregnancy?
Category: Health Questionnaire