• Center for Women's Health

    International Obstetrics Questionnaire
  • Instructions

    1. If unsure, use your best guess.
    2. Input "idk" for any unknown answers.
    3. If you have any questions, please email us at nurse@cfwhguam.com
    4. Please "SUBMIT" form when complete.  Do not leave page until receiving "Thank You" message.

    * Required fields

  • Citizens and legal residents of the United States should complete our domestic questionnaire.  Please click HERE for the correct form.

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    • None - patient has no working knowledge of English
    • Basic / Elementary - patient has trouble communicating in English. Patient can only understand or speak few words.
    • Limited working - able with difficulty to answer and ask questions during exams. 
    • Professional Working - able with little difficulty to answer and ask questions during exams
    • Fluent - able with no difficulty to answer and ask questions during exam
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  • Fees $$$

  • 1. Hospital: This fee is owed to the hospital where the delivery and postpartum care takes place. Inquire at Guam Memorial Hospital for exact amount of fees.

    2. Anesthesia: Most anesthesiologist do not work for the hospital and are in fact private contractors.  They most often bill for their services separately from the hospital. Inquire at Guam Memorial Hospital for exact amount of fees.

    3. Diagnostic Imaging: You will likely be required by the doctor to get one ultrasound from a licensed radiologist. This ranges from $250 - $400 and can be paid with credit card at the time of service.

    4. Laboratory Testing: Even late in the pregnancy there are some laboratory fees possible.  This usually is less than $100 paid directly to the laboratory service.

    5. Professional fees: This is our fee. CFWH global fee includes prenatal visits, delivery the baby at Guam Memorial Hospital, pospartum visits and bedside ultrasounds.  It does not include any fees mentioned above.  It does not include TDAP injection, fetal non-stress test (NST) if required, or other services not generally included in a normal pregnancy. All payments must be made in cash. Please contact our office for the latest pricing.

  • Current Pregnancy

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  • Center for Women's Health
    744 N Marine Corps Dr
    Ste 121
    Tamuning, GU 96913
    USA
  • In addition to providing the prenatal records before the first visit with us, we require the patient to arrive on Guam prior to the 35th week of pregnancy.  We can help you calculate this date.

  • Obstetrics History

  • Input Order: oldest to most recent

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  • Medical History

  • Social History

  • If you have further questions, please contact us at

    +1 671-988-4093

    or

    nurse@cfwhguam.com

  • Do not enter information in the fields below.

    Center for Women's Health only.
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