When was your last influenza vaccine? Date When was your last pneumonia vaccine? Date Never had flu vaccine Never had pneumonia vaccine
What is your marital status? please type How many children do you have? please type
What is your occupation? please type
How many drinks per week? please enter a number For your reference, one drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits
How old were you when you had your first menstrual cycle? please type Are your cycles regular? please type What was the date your last menstrual cycle started? please typeHave you gone through menopause? please typeHow many times have you been pregnant? please typeHow many children do you have? please typeHow many miscarriages have you had? please type