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Teenage Pregnancy Survey Form Template

Understand the factors influencing teenage pregnancy with our survey template

Developing a clear understanding of teenage pregnancy can be challenging, but this survey template helps educators and health professionals gather essential insights. By using this template, you can uncover trends, assess knowledge gaps, and identify areas for intervention, all while ensuring your survey follows ethical guidelines. It offers WCAG-aligned labels for accessibility, making it easy for respondents to complete. Streamline your research process and start collecting vital data today.

Use this Template (FREE) Live Preview
Are you aged 13 to 19?
Yes
No
Do you consent to take part in this anonymous survey?
Yes
No
What is your age in years?
Which of the following best describes your gender?
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
What is your current education or training status?
In school (secondary/high school)
In college or sixth form
In training/apprenticeship
Working (not in education or training)
Not in education, employment, or training
Prefer not to say
Have you ever been pregnant?
Yes
No
Prefer not to say
What is your current pregnancy status?
Currently pregnant
Gave birth in the last 12 months
Had a pregnancy loss in the last 12 months
Not currently pregnant
Prefer not to say
If you have been pregnant, what were the outcome(s)?
Live birth
Miscarriage
Abortion
Ectopic pregnancy
Still pregnant
Not applicable
Prefer not to say
Have you ever had sexual intercourse?
Yes
No
Prefer not to say
In the last 12 months, how often did you or a partner use contraception when you had sex?
Always
Often
Sometimes
Rarely
Never
Not applicable
Prefer not to say
Which contraception methods have you used in the past year? Select all that apply.
Where would you usually get contraception or sexual health advice? Select all that apply.
How easy is it to access sexual health services where you live?
Very difficult
Difficult
Neutral
Easy
Very easy
Have you received pregnancy prevention education at school or in a program?
Yes, comprehensive
Yes, some
No
Not sure
Prefer not to say
If you are or were pregnant, did you have support from a parent or guardian?
Yes
No
Not applicable
Prefer not to say
If you are or were pregnant, did you have support from a partner?
Yes
No
Not applicable
Prefer not to say
Do you feel safe in your current relationship(s)?
Yes
No
Not applicable
Prefer not to say
What are the biggest barriers to preventing teen pregnancy in your area? Select all that apply.
Please Specify:
How likely are you to use an online service to get contraception or sexual health advice?
0 Not at all likely
1
2
3
4
5 Extremely likely
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Paper art illustration depicting a teenage pregnancy survey form for FormCreatorAI article

When to use this form

Use this survey when you need a clear view of teens' knowledge, attitudes, and support needs around pregnancy. It fits school health classes, youth clinics, and community programs. Run it after a lesson, during a counseling week, or before updating curricula. Responses help you tailor messages, connect students to services, and spot gaps by grade or region. For broader context, pair it with the Student survey form to track general wellbeing and trust. To monitor changes week to week, add a Student daily feedback form after lessons or events. Keep it anonymous and voluntary to protect privacy and improve honesty.

Must Ask Teenage Pregnancy Survey Questions

  1. What is your age range and current grade level?

    This lets you segment responses and adjust content to maturity and curriculum. It also helps you compare trends across grades and set age-appropriate follow-ups.

  2. How confident do you feel in understanding ways to prevent pregnancy?

    Confidence ratings show where knowledge is weak, so you can target education on methods and access. They also give you a baseline you can track over time alongside an Exit ticket form after key sessions.

  3. Where do you usually get information about sexual health? (Select all that apply)

    Source data tells you which channels to invest in, such as classes, social media, or clinics. It also reveals gaps if students rely on peers more than trusted sources.

  4. If you or a friend needed help related to pregnancy, whom would you feel comfortable approaching?

    This identifies trusted adults and services, so you can strengthen referral paths. It also helps you plan staff training and partnerships that match student preferences.

  5. What barriers could prevent you from getting contraception, testing, or counseling?

    Common barriers include cost, transport, privacy, or stigma; knowing them helps you remove friction. You can then adjust location, hours, and communication to improve access and reduce risk.

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