Fertility Questionnaire Responses

Please check your responses below

How often do your periods come? Every days
Length of bleed: days
Are your periods painful?
Are your periods heavy?
Do you bleed between periods?
Date of last period:

Do you have pain during sexual intercourse?
Do you have any vaginal discharge?
When was your last smear test?
Have you ever had an abnormal smear test?
Have you ever had any treatment to the cervix?
Have you had any gynaecological surgery?
Have you had any previous gynaecological problems?
Have you ever had a sexually transmitted infection?

How many pregnancies have you had?
How many children do you have?
Have you had any pregnancy complications?
What contraception do you use?

Name: Grace
Email: graceedcu@gmail.com
Date of birth: 1990-03-20

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