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Answer the following questions to help determine if you could be pregnant:
Are you sexually active? Yes No
Have you had unprotected sex? Yes No
Have you used protection but are concerned that it may have failed? (the condom broke, birth control pills didn’t work, etc.)? Yes No
Are you late for, or have you missed, your menstrual period? Yes No
Are you having any symptoms of pregnancy? Yes No
If you are having symptoms, which are you experiencing? Nausea/Vomiting Headaches Backaches Frequent Urination Swollen/Tender Breasts