My Pregnancy


1258 High Street, Eugene, OR 97401

Phone 541-342-8437 | Fax 541-242-2999

Name:     Date:

Please respond to the following items about yourself and the baby you are expecting.  There are no right or wrong answers.  Your first impression is usually the best reflection of your feelings. 

I think or do the following:

I talk to my unborn baby.

I feel all the trouble of being pregnant is worth it.

I enjoy watching my tummy jiggle as the baby kicks inside.

I picture myself feeding the baby.

I’m really looking forward to seeing what the baby looks like.

I wonder if the baby feels cramped in there.

I refer to my baby by a nickname.

I imagine myself taking care of the baby.

I can almost guess what my baby's personality will be from the way she/he moves around.

I have decided on a name for a girl baby.

I do things to try and stay healthy that I would not do if I were not pregnant.

I wonder if the baby can hear inside of me.

I have decided on a name for a boy baby.

I wonder if the baby thinks and feels 'things' inside of me.

I eat meat and vegetables to be sure my baby gets a good diet.

It seems my baby kicks and moves to tell me it's eating time.

I poke my baby to get him/her to poke back.

I can hardly wait to hold the baby.

I try to picture what the baby will look like.

I stroke my tummy to quiet the baby when there is too much kicking.

I can tell that the baby has the hiccoughs (hiccups).

I feel my body is ugly.

I give up doing certain things because I want to help my baby.

I grasp my baby's foot through my tummy to move it around.

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: My Pregnancy
lock iconUnique Document ID: 2fc39cbfd7b8d5129d5c2a1b6dd9b2d5a685ee61
Timestamp Audit
December 4, 2023 10:37 am PDTMy Pregnancy Uploaded by Jason Dooley - main@c-f-d.org IP 192.111.94.2
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://esign.c-f-d.org/
Audit Trail Serial# c0fa1696dee70d1523dd5c3a4d099666