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(Choose date)
My cycle is
I think I may be pregnant, because…
6.a
(Choose all that apply)
Since my last period, I had sex or was physically intimate:

What could have impacted my period?

(Choose all that apply)

I am experiencing the following symptoms, which make me think I may be pregnant:

(Choose all that apply)

Since my last period, I had sex or was physically intimate:
If you were pregnant, how would you react?
If you were pregnant, how would you react?
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