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Blank No.26 Series II Form B. 6.
12- What knowledge of sexual physiology had you before marriage?
(b)how did you obtain it?
Very little, obtained from reading physiology and Naphey's book on women. (I can not give the title)

13- Number of times married. If more than once additional blanks will be furnished you to answer the following questions [separately?] in regard to each marriage? Once
14- Number of years married? Nine months.
15- Do you habitually sleep with your husband? (b) What reasons for so doing or not? I did.
16- Number of conceptions? None
17- Number of children? State in connection with each (a) date of birth? (b) sex (c)whether healthy or not? (d)note any characteristic and the cause. (e)note either immediate or after effect on your health of the birth of each of your children. (f)give time of first menstruation after birth of each child.