Get Birth Control Questionnaire - University Of Mary Washington - Students Umw

Filling out the Birth Control Questionnaire is a crucial step for students at the University of Mary Washington seeking birth control options at the Student Health Center. This guide will walk you through each section of the questionnaire to ensure you provide all necessary information clearly and accurately.

Follow the steps to successfully complete the Birth Control Questionnaire online.

1. Select the ‘Get Form’ button to access the questionnaire in an editable format.
2. Begin by entering your name in the designated field.
3. Answer the age question by providing your current age.
4. If you are sexually active, indicate at what age you had your first intercourse.
5. Choose the type of birth control you are interested in from the provided options.
6. Indicate whether you have previously used any form of birth control, and if so, provide details.
7. State if you have had any issues with birth control in the past, along with explanations if applicable.
8. List any medical conditions you have or have previously had that may affect your birth control options.
9. Indicate if any close relatives have had blood clot issues and provide details if necessary.
10. Answer questions regarding a history of breast cancer, severe headaches, smoking habits, and pregnancy status.
11. Provide information about your last menstrual period and any recent unprotected sex.
12. List any current medications and significant health concerns you may have.
13. Fill in any additional comments or questions you might have for the health center.
14. Finally, specify how you would like to be contacted by the nurse, and ensure your signature and date are included.

Complete the Birth Control Questionnaire online today to take the next step in your reproductive health.