[Instructions: Answer the questions honestly and to the best of your knowledge.]**
Question 1: Missed Period
a) My period is late by:
i) Less than a week
ii) 1 to 2 weeks
iii) More than 2 weeks
Question 2: Breast Tenderness
a) Are your breasts:
i) Slightly tender
ii) Significantly tender
iii) Not tender at all
Question 3: Nausea or Vomiting (Morning Sickness)
a) Do you feel:
i) Occasional nausea
ii) Frequent nausea and/or vomiting
iii) No nausea or vomiting
Question 4: Changes in Appetite
a) Has your appetite:
i) Increased
ii) Decreased
iii) Stayed the same
Question 5: Fatigue or Exhaustion
a) Are you feeling:
i) Constantly fatigued or exhausted
ii) Occasional tiredness
iii) Normal energy levels
Question 6: Frequent Urination
a) Do you have:
i) Increased urge to urinate
ii) Occasional frequent urination
iii) Normal urination habits
Question 7: Spotting or Bleeding
a) Have you experienced:
i) Light bleeding or spotting
ii) No bleeding or spotting
iii) Heavy bleeding similar to a menstrual period
Question 8: Mood Changes
a) Do you feel:
i) Frequent mood swings or irritability
ii) Occasional mood changes
iii) No noticeable mood changes
Question 9: Bloating or Gas
a) Are you experiencing:
i) Bloating or excessive gas
ii) Slight bloating
iii) No noticeable bloating
Question 10: Over-the-Counter Pregnancy Test
a) Did you take an over-the-counter pregnancy test with the following results:
i) Positive
ii) Negative
iii) Not taken yet
Results Interpretation
- Mostly "i" Responses: There's a chance that you might be pregnant. It is advisable to take a pregnancy test to confirm.
- Mostly "ii" Responses: You may or may not be pregnant. Taking a pregnancy test can provide a more definitive answer.
- Mostly "iii" Responses: Pregnancy is less likely, but you can confirm with a pregnancy test if you have any doubts.
Remember, some conditions or factors can cause similar symptoms to those in early pregnancy. It is important to consult with a healthcare professional or take a pregnancy test to get an accurate assessment of your situation. Your healthcare provider is best equipped to offer personalized advice and support.
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