Pregnancy Doctors Visit Form
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1Doctor Visit
9 – 13 Weeks
Physician or Midwife:
Second Exam:
Blood Pressure:
Changes?
Urine Sample:
Signs of Preeclampsia?
Weight:
Weight Gained:
Uterus Size:
Tested:
Vaginally
Belly
Ultrasound
Nuchal Translucency Screening Test (NT Scan):
Risks for:
Down Syndrome
Chorionic Villus Sampling (CVS)
Amniocentesis
Carrier Screening for Mother:
Blood
Saliva
Carrier for:
Cystic Fibrosis
Sickle Cell Disease
Thalassemia
Tay-Sachs
Carrier Screening for Father:
Blood
Saliva
Carrier for:
Cystic Fibrosis
Sickle Cell Disease
Thalassemia
Tay-Sachs
Treatment Plan:
Genetic Counselor:
Phone:
Tests Done
Pelvic Exam
Result:
Breast Exam
Result:
Pap Smear
Result:
Ultrasound
Result:
Doppler Scan
Result:
Blood Test
Result:
Things to Do
New Info:
Food to Eat:
Exercises to Do:
Warning Signs:
Questions for Next Appt.
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Parent category: Miscellaneous