Preparing for a healthy Pregnancyy

Dear Concerned Parent or Parent-to-be,

START HERE. Take five minutes to complete our complimentary Autism Risk Review. Determine your risk level and learn some simple changes you can make in your environment and lifestyle right away.

In designing this questionnaire, I’ve incorporated known and suspected risk factors identified from my years of experience working with families, and in the medical literature.  It is designed to be sensitive, and to help guide parents toward changes in their lifestyle which will increase the chances of a healthy pregnancy.

PLEASE NOTE: This assessment is NOT designed to  diagnose, predict autism risk or substitute for medical care. Instead it is intended to educate and help you address important changes to help you grow a healthy child.

- John Green MD

Please enter your Email ID before starting the quiz:

Email
Name
1.

For prospective mothers-

Check all that apply.
Do you or your biological child (if applicable) have any of the following:

1 out of 36
2.

For prospective mothers-

Check all that apply.
Do you have a close relative (sibling, parent, aunt or uncle) who has:

2 out of 36
3.

For prospective mothers-

Do you have a history of infertility or miscarriage?

3 out of 36
4.

For prospective mothers-

Do you have a history of in vitro fertilization?

4 out of 36
5.

For prospective mothers-

Are you older than 40?

5 out of 36
6.

For prospective mothers-

Have you had a C section?

6 out of 36
7.

For prospective mothers-

Do you take one of these prescription medications:
Prozac (fluoxetine)
Zoloft (sertraline)
Other SSRI
Depakote or Depakene (valproic acid)?

7 out of 36
8.

For prospective mothers-

Check all that apply.
Do you have a family history (parents, sibling, aunt or uncle) of any of the following diseases?

8 out of 36
9.

For prospective mothers-

Do you have mercury ("silver") fillings in your mouth?

9 out of 36
10.

For prospective mothers-

Have you received the flu vaccine (which contains aluminum or thimerosal as preservatives) in the last 5 years?

10 out of 36
11.

For prospective mothers-

Do you live in a home built before 1975, or have you been exposed to lead through water or soil contamination?

11 out of 36
12.

For prospective mothers-

Are you regularly or heavily exposed to pesticides?  Examples are living near commercially sprayed fields or Christmas tree farms, golf courses, treated lawns or homes fumigated for pest control.

12 out of 36
13.

For prospective mothers-

Has your home been remodeled or re-carpeted with synthetic material in the last 5 years?

13 out of 36
14.

For prospective mothers-

Do you live near an oil refinery, coal fired power plant, large trash burner or Superfund site?

14 out of 36
15.

For prospective mothers-

Do you work in or have regular exposure to a toxic environment?
Examples are welding, electronics manufacture, working with volatile compounds such as varnishes, indoor shooting range, solvents, lacquers, volatile glues, etc.

15 out of 36
16.

For prospective mothers-

Do you smoke cigarettes?

16 out of 36
17.

For prospective mothers-

Do you live within two blocks or a freeway or very busy street?

17 out of 36
18.

For prospective mothers-

Do you live within 1/2 mile of a cell phone tower?

18 out of 36
19.

For prospective mothers-

Do you have a smart meter on your house?  Smart meters are being used by utility companies to remotely measure gas or electricity consumption and emit regular pulsed radiation.

19 out of 36
20.

For prospective mothers-

Do you have wifi in your home?

20 out of 36
21.

For prospective mothers-

Do you have a cordless landline phone in your home?  If you don't know what this is, the answer is no.

21 out of 36
22.

For prospective mothers-

Do you use a cell phone?

22 out of 36
23.

For prospective fathers-

Check all that apply.  Do you or your biological child (if applicable) have any of the following:

Please note: If you are the biological father of a child mentioned in question #1 and your child has any of the following issues, please check the last option: "Yes I have a child with one of these conditions…"

23 out of 36
24.

For prospective fathers-

Check all that apply.
Do you have a close relative (sibling, parent, aunt or uncle) who has:

24 out of 36
25.

For prospective fathers-

Are you older than 45?

25 out of 36
26.

Do you have a history of male infertility?

26 out of 36
27.

For prospective fathers-

Check all that apply.
Do you have a family history (parents, sibling, aunt or uncle) of any of the following diseases?

27 out of 36
28.

For prospective fathers-

Do you have mercury ("silver") fillings in your mouth?

28 out of 36
29.

For prospective fathers-

Have you received the flu vaccine (which contains aluminum or thimerosal as preservatives) in the last 5 years?

29 out of 36
30.

For prospective fathers-

Do you work in or have regular exposure to a toxic environment?
Examples are welding, electronics manufacture, working with volatile compounds such as varnishes, indoor shooting range, solvents, lacquers, volatile glues, etc.

30 out of 36
31.

For prospective fathers-

Do you smoke cigarettes?

31 out of 36
32.

For prospective fathers-

Do you live within 1/2 mile of a cell phone tower?

32 out of 36
33.

For prospective fathers-

Do you have a smart meter on your house?  Smart meters are being used by utility companies to remotely measure gas or electricity consumption and emit regular pulsed radiation.

33 out of 36
34.

For prospective fathers-

Do you have wifi in your home?

34 out of 36
35.

For prospective fathers-

Do you have a cordless landline phone in your home?  If you don't know what this is, the answer is no.

35 out of 36
36.

For prospective fathers-

Do you use a cell phone?

36 out of 36