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Blank No. 16 B Series II. Form B. 7.

18 - Did conception occur by choice or accident?
19 - Habit of intercourse, average number of times per week? ---
per month? 3 per year?
20 - Was intercourse held during prenancy? If so, how often?
b) had you any desire for it during this period?
21 - [deleted]At other times[deleted] have you any desire for intercourse? yes
a) how often? b) at what time in relation toyour menses?
a) 3 or 4 times per month. b) --------

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