Are you Ready to Become a Parent?

Do you smoke, drink, or use drugs?

No/sometimes, but it isn't a habit

Yes, I do at least one of these activities regularly

Which of the following best describes your relationship status?

Single or widowed

Married or cohabiting, having been in a relationship/marriage, for 5+ years

In a relationship (less than 5 years)

In a polygamous relationship

Do you have a sexually transmitted infection?

Yes

I suspect that I may have one

Are you employed?

Yes, or I plan to become employed in the near future/my significant other is employed

How many hours do you work a day?

10 or less

More than 10

I am not employed

How much do you and/or your partner make per year?

Based on your past experiences with children, do you enjoy spending time with children?

Yes

Have you taken a Parenting course, or are taking one currently?

Yes, or am I considering taking one

Have you ever done volunteer work with children, or babysat/supervised childen?

Yes

Do you communicate well with your significant other?

Yes

I do not have a significant other/am in a polygamous relationship

Do you often find that you are busy and have little time to yourself?

Yes

Would you describe yourself as compassionate?

Yes, I would describe myself as relatively compassionate

Are you honest towards others?

I don't remember the last time I told a lie

No, I often find myself lying to others

Do you often find yourself skipping meals, showers, or any other activities in which you are maintaining your personal health or hygiene?

Yes, often

Never!

How regularly do you get a checkup at the doctor's office?

Never

At least once every 6-12 months

Every other year or less

Does your healthcare provider describe you as healthy when you go for a checkup?

Yes

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