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Blank No. 3 Series II. Form B. 7

18 - Did conception occur by choice or accident?
First time- accident.
Second "- Choice with accident.
Third " " " ".

19 - Habit of intercourse, average number of times per week?
per month? Six or more. per year?

20 - Was intercourse held during pregnancy? If so, how often?
b) had you any desire for it during this period?
Yes - Two or three times per month. (b) Yes, in one case.

21 - At other times have you any desire for intercourse?
a) how often? b) at what time in relation to your menses?
(a) Infrequent intervals. (b) Can not see any relation.

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