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?
Physical Health Questionnaire
Health Fitness Questionnaire
Health Performance Questionnaire
Health Care Assessment Questionnaire
Health Fitness Assessment Questionnaire
Health Self Assessment Questionnaire
Health Interview Survey Questionnaire
Health Care Preferences Questionnaire
Health Demographics Questionnaire
Health Care Consumer Questionnaire
Medical Health Questionnaire
Sexual Health Questionnaire