"Pregnancy Journal Template - 40-41 Weeks Doctor Visit"

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Doctor Visit
40 – 41 Weeks
Physician or Midwife:
Eleventh Exam:
Blood Pressure:
Changes?
Urine Sample:
Signs of Preeclampsia?
Weight:
Weight Gained:
Nausea?
Baby Movements:
Swelling in Hands:
Swelling in Feet:
Headaches:
UTIs:
Contractions:
Frequency:
Leaking Fluid:
Spotting/Bleeding:
Baby Breeched:
Baby Dropped:
Past Due Date:
Cervix is
Thinning
Softening
Dilating
Uterus Size:
Tested:
Vaginally
Belly
Ultrasound
Baby’s Heartbeat:
Growth Rate:
Tests Done
Pelvic Exam
Result:
Breast Exam
Result:
Pap Smear
Result:
Ultrasound
Result:
Doppler Scan
Result:
Blood Test
Result:
Things to Do
Food to Eat:
Exercises to Do:
Classes to Take:
Books to Read:
Warning Signs:
Birth Plan:
Questions for Next Appt.
www.FreePrintableMedicalForms.com
Doctor Visit
40 – 41 Weeks
Physician or Midwife:
Eleventh Exam:
Blood Pressure:
Changes?
Urine Sample:
Signs of Preeclampsia?
Weight:
Weight Gained:
Nausea?
Baby Movements:
Swelling in Hands:
Swelling in Feet:
Headaches:
UTIs:
Contractions:
Frequency:
Leaking Fluid:
Spotting/Bleeding:
Baby Breeched:
Baby Dropped:
Past Due Date:
Cervix is
Thinning
Softening
Dilating
Uterus Size:
Tested:
Vaginally
Belly
Ultrasound
Baby’s Heartbeat:
Growth Rate:
Tests Done
Pelvic Exam
Result:
Breast Exam
Result:
Pap Smear
Result:
Ultrasound
Result:
Doppler Scan
Result:
Blood Test
Result:
Things to Do
Food to Eat:
Exercises to Do:
Classes to Take:
Books to Read:
Warning Signs:
Birth Plan:
Questions for Next Appt.
www.FreePrintableMedicalForms.com