1. How old are you?

2. Do you smoke?

3. Do you eat healthy quantities of fruits and vegetables regularly?

4. How old were you when you had your first sexual encounter?

5. How many sexual partners have you had?

6. Do you use contraceptives like condoms/diaphragms?

7. Have you ever been diagnosed with the following?

8. When was your last Pap smear and HPV test?

9. Do you have a family history of cervical cancer?

10. Have you taken the HPV vaccine for cervical cancer?

11. Do you use oral contraceptives (Birth control pills)?