GYNECOLOGIC HISTORY QUESTIONNAIRE
(Including vasectomy, tubal ligation, condoms, abstinence, or natural family planning methods)
OBSTETRICAL HISTORY
(including miscarriages and abortions)
(include dates and types of deliveries)
(i.e. Tay-Sachs, Spina Bifida, Down Syndrome, other genetic disorder)
GYNECOLOGICAL HISTORY
(loss of urine when coughing, sneezing, etc.)
MEDICAL HISTORY
FAMILY HISTORY
SOCIAL HISTORY
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