4. Womens health
What is the purpose of your consultation?
Antenatal Care
Fertility Issues
Family Planning
Menstrual Problems
Other
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Are you currently pregnant?
Yes
No
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When was your last menstrual period?
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Are you using any form of contraception?
Oral Pills
Intrauterine device (IUD)
Implant
None
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Do you have a history of gynecological conditions?
Yes
No
Details
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First Name
Last Name
Email
Phone/Mobile
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