1 - ESDS
1 - ESDS
1 - ESDS
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DWQ50 WIIkh of the fallowingmdhod(s) of preventingpmgnaccy,f any, did<br />
YOUUSIMY U= hmnmdiddY b9foM mao<br />
If WU had no SUIUI relmlfc+whlp,ttng .--—_-<br />
If no nmthod usad at ●u, ring .. . . . . . . . . . . .<br />
If you W8N pt’qrmnt. ring ..---,...- . . ..————<br />
N usually using 0n9 al mom M@md5,tings lfthontnnbws<br />
ftmt apply<br />
Wlthdmwal ........................... .. ......... . ....... ..... ..............<br />
Shdhlcomlom .............. .. ......... ........ ................ ... . .....<br />
Sati pmid~m mathnd. .......... . ...............................<br />
C@dbphmgm .. . ............... ............ .............. ............<br />
Ca4mapmc 8p0ngc ... ........... .. ....... ....................... ....<br />
Plk mid pill(pfogmbmn only) ..... ....... .......... ......... ......<br />
Pin cambimd PU(Includingmulfl.phadcPtil) .. ...............<br />
PW notsum if rnlrdor cambkmd<br />
Plea- wdta the bmnd nmm mow -----------<br />
luo/mi4Lntm.uhrlm ** ......... ..... ............. ................<br />
FomTWgaWWyUpaanwtaa (qww@id9s) . ....................<br />
Goingwithout$oxtmlitiercauma to avoidpmgtmmf ........<br />
Inlcctbns .. ........ ............................................... ................<br />
Anottwrmethod<br />
PlomssWti iti O- balow..----—----<br />
Owasl TO TNOSE NOT PREQNANT ANO WHO HAVE NOT NAO ANY<br />
OPERATfON TNAT PNEVf!NTS PRSONANCY<br />
Vvhkh of OMhMowingmah0d9 of preventingpmgnaw ifany, am you<br />
(atI0 yourFOmmr)uuliy uing at pmaont?<br />
If ymuhad no sexual mfatfanship, ring . .. . . . . .<br />
If no Ilmth4d used ●t ●l! ring .,-----------------<br />
If usually using OM or mom nwthoda ring ●ll tha nmbma<br />
that ●flflly<br />
Wmdrawml..........................................................................<br />
Shdhfmtiom ..................................................................<br />
Sah pmtod?thyth mathod ......... .......... .................... ....<br />
C.3pldiw+mgm ...................................................................<br />
Contmc@#* 8p0q* .........................................................<br />
Pm miniPN(prowstuon onty) ...... ......... ......................<br />
Pllt combinedF41(Inciwdingmult!-pharncpiU)<br />
Pllt notsum ifminiw combined<br />
PINU wtita tfm bmnd nama Lwtow.... . . . . . . . .<br />
Iuokdorttra.utelim davica ................................................<br />
FaanWgds(apmyWwssmies (sPermicides) .... .. ...........<br />
Go~ ~tiui sexualimO~u* to avoidpregnancy . . . .<br />
lnjactmns.............................................................................<br />
Anolhermathod<br />
Pleasa write its nama below .......... . . ... . . . . .<br />
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— Returnformto<br />
h$mviewer<br />
Total ntmnbmof<br />
ti8annth0d<br />
Cimd<br />
I n=t4 I<br />
— GOtom.msr<br />
— Go to D~SiAS<br />
— Go to DlWJ52
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