Thank you for coming to our facility and allowing us the opportunity to serve you.
We sometimes ask for the cooperation of our patients by asking “personal” but necessary and important questions in order to provide quality care.
Are you pregnant or do you think you may be?
Have you recently had a pregnancy test?
If yes, test date?
Do you have menstrual cycles?
Last menstrual period start date:
Do you practice birth control?
Please indicate the method of birth control:
Have you been sexually active since your last menstrual period?