Get Co Request For Pregnancy Test 2018-2026

Completing the CO Request for Pregnancy Test online can be a straightforward process. This guide will walk you through each section and field of the form, ensuring that you understand what information is required and how to submit it correctly.

Follow the steps to complete your request effortlessly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Fill in the date at the top of the form. Ensure that you enter the current date accurately.
3. Provide your full name in the designated field, ensuring that it is clearly legible.
4. Enter your complete address, including your city, state, and zip code. This information is crucial for contact purposes.
5. Indicate your birth date. This helps verify your age, which is requested in the next field.
6. Complete the age section by entering your current age.
7. For the race section, mark all of the categories that apply to you. Be honest and thorough in your selections.
8. In the ethnicity section, please specify whether you identify as Hispanic by choosing 'Yes' or 'No.'
9. Respond to the question about your feelings regarding the possibility of becoming pregnant by checking the answer that best reflects your situation.
10. Indicate whether you have any symptoms of pregnancy. If yes, list them in the provided space.
11. Record the first day of your last menstrual period in the appropriate field.
12. Answer the question regarding the normalcy of your last period by selecting 'Yes' or 'No.'
13. Provide the date of your last act of intercourse.
14. Select the method of birth control you used, if any, by checking the appropriate box.
15. If your pregnancy test result comes back negative, indicate if you are interested in a method of birth control.
16. If pregnant, select any referrals you may want, such as prenatal care or other options.
17. Answer the question about your healthcare provider for regular sickness visits.
18. Record the number of pregnancies, births, miscarriages, and abortions you have experienced.
19. Indicate whether you smoke cigarettes.
20. Provide the number of people in your household.
21. Fill in your household's annual income.
22. Read the statement regarding the request for a pregnancy test carefully. Then, sign and date the form to confirm your request.
23. Once all fields are complete, you can save your changes, download the form, print it, or share it as necessary.

Complete your CO Request for Pregnancy Test online today for a smooth experience.