Pregnancy and Caffeine
Thank you for your participation.
Sign in to Google to save your progress. Learn more
Age *
How many weeks of Pregnancy   *
(If not pregnant, indicate N/A)
Do you consume caffeine on a daily basis? *
(Coffee/Tea/Soft drinks such as coke, root beer, etc.)
What sort of caffeine containing products do you consume? *
Required
It is very difficult for me to quit drinking coffee *
When I do not drink products with caffeine, I feel very tired *
Does your family members or love ones around you encourage you to decrease your intake of caffeine? *
How much caffeine is acceptable during pregnancy? *
Does drinking caffeine when pregnant leads to problems related to your baby? *
Would you cut down your caffeine intake for your baby? *
What sort of problems will you encounter if you consume excessive caffeine daily (More than 300 mg) *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms