1. Have you missed a period?

Yes
No

2. Are you experiencing nausea or morning sickness?

Yes
No

3. Do you feel more tired than usual?

Yes
No

4. Have you noticed changes in your breasts (tenderness, swelling, or darkened areolas)?

Yes
No

5. Are you experiencing mood swings or heightened emotions?

Yes
No

6. Have you been using contraception (birth control, condoms, IUD, etc.)?

No
Yes

7. Are you peeing more frequently than usual?

Yes
No

8. Have you noticed unusual cravings or food aversions?

Yes
No

9. Have you been experiencing frequent headaches?

Yes
No