Get Co Request For Pregnancy Test 2009-2025

Filling out the CO Request for Pregnancy Test form online is a straightforward process that ensures your request for a pregnancy test is submitted accurately and securely. This guide provides step-by-step instructions to help you complete the form with confidence and ease.

Follow the steps to complete the form online effectively.

1. Press the ‘Get Form’ button to access the document and open it using an online document editor.
2. Begin by entering your name on the designated line. Make sure to use your full legal name as this will be required for processing.
3. Input your age in the appropriate field, as this information may be relevant for your healthcare provider.
4. Fill in your date of birth (DOB) in the provided format, ensuring that it is accurate and reflects your true birth date.
5. Provide your contact number where you can be reached for follow-up questions or results.
6. Enter your residential address, city, state, and zip code to ensure that your request is correctly associated with your location.
7. Mark all applicable races in the race section, ensuring that you select all that apply to you.
8. Select the response that best reflects your feelings about becoming pregnant by checking the appropriate option.
9. Indicate whether you are a smoker by selecting 'Yes' or 'No'.
10. In the symptoms of pregnancy section, indicate if you have any symptoms and provide details if applicable.
11. Record the first day of your last menstrual period and confirm whether it was a normal period.
12. Date your last act of intercourse in the specified section.
13. Choose the method of birth control used from the provided options by checking all that apply.
14. If applicable, indicate if you are interested in a method of birth control in case the pregnancy test is negative.
15. Select your preferences regarding referrals and any additional healthcare services if you are pregnant.
16. Complete personal history questions, including number of pregnancies, births, miscarriages, and abortions.
17. Fill in your household annual income and the number of people living in your household.
18. Sign and date the form to certify your request and your understanding of the terms provided.
19. Once all sections are completed and reviewed, save your changes, and consider downloading or printing the form for your records.

Take the next step towards your health by completing the CO Request for Pregnancy Test form online today.