Prenatal Diagnosis Decision-Making Questionnaire Form
Please complete this brief questionnaire to help us understand your decision-making process regarding prenatal diagnosis. Your responses are confidential and will guide supportive care.
How many weeks pregnant are you?
*
What is your age?
*
What is your current understanding of prenatal diagnostic testing?
*
Very good
Good
Basic
Limited
None
What is your main reason for considering prenatal diagnostic testing?
*
Personal or family history
Doctor’s recommendation
General curiosity
Concern about baby’s health
Other
How confident do you feel about making a decision regarding prenatal diagnostic testing?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which of the following factors are most important to you when making this decision? (Select up to 3)
*
Accuracy of test
Safety for the baby
Cost
Doctor’s advice
Family opinion
Religious or cultural beliefs
Other
How comfortable are you with the information you have received so far?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
If prenatal diagnostic testing reveals a high risk result, how likely are you to seek further counseling?
*
Very likely
Somewhat likely
Unsure
Not likely
Would you like additional resources or support regarding prenatal diagnosis?
*
Yes, please provide more information
No, I have enough information
Please share any additional thoughts or questions about your decision-making process.
Submit
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