When are you due to start your next period?
Have you taken a pregnancy test in the last 7 days?
What form of birth control are you currently using?
Have you recently noticed any changes to your breasts? (Select all that apply)
Have you experienced any nausea in the past two weeks?
Have you noticed any differences in your appetite?
Do you find yourself needing to urinate frequently?
How would you describe your energy?
How would you describe your general mood over the last 1-3 weeks?