Free Pregnancy Verification Forms (Word) – Everything to Know

A pregnancy verification form is a written document to show proof of a positive pregnancy test.

The form confirms that a woman is indeed pregnant, and it provides further details concerning the specific pregnancy test. The form is every day in hospitals, maternity, and lying-in clinic settings. The form is usually issued by a licensed medical expert taking care of the pregnant mother and developing fetus. Fundamentally, the use of the form is advantageous due to the following reasons:

Free Forms

Great Professional Pregnancy Verification Letter Template for Word File
Free Editable Pregnancy Verification Form 01 for Word Document
Free Editable Pregnancy Verification Form 02 for Word Document
Great Professional Out-of-Institution Birth Pregnancy Verification Form for Word File
Great Professional Pregnancy Certificate Template for Word File
Great Professional Pregnancy Verification Statement Template for Word File
Free Editable Pregnancy Confirmation Form 01 for Word Document
Free Editable Pregnancy Confirmation Form 02 for Word Document
Great Professional Employee Pregnancy Confirmation Form for Word File
Free Editable Pregnancy Confirmation Form 03 for Word Document
Free Editable Pregnancy Verification Form 03 for Word Document
Free Editable Pregnancy Verification Form 04 for Word Document
Free Editable Pregnancy Verification Form 05 for Word Document
Great Professional Ohio Pregnancy Affidavit Form for Word File

    Purpose of the Pregnancy Verification Form

    The form provides details of an individual’s pregnancy, including the hospital/clinic visitation date, the estimated conception date, the last menstrual period, the estimated delivery date, age of gestation, the number of fetuses, and any other additional notes concerning the woman’s health and that of the unborn child.

    Recording a pregnant woman’s information is essential as it indirectly records the fetuses’ growth and development. It helps the gynecologists/ Obstetricians to understand the health status of the expectant woman and the growth of the developing fetus over time, which may be necessary during future clinic visits.

    • First and most importantly, the form acts as proof of a positive pregnancy test. This means that the pregnant woman can use it to file for maternity leave or make time-off requests from their employer, especially where one has to make multiple visits to the clinic or medical expert.
    • The form is essential when one is claiming health insurance for pregnancy from insurance companies. With the form, one doesn’t have to go through the long and tedious insurance claim investigations from the insurer, as it is already enough justification.
    • The form is proof of pregnancy based on medical practitioner’s tests. This will come in handy during future medical examinations and tests on the mother and fetuses’ health.
    • The form also records the medical history and complications associated with pregnancy and usually estimates when the child could be born. This may be helpful when answering questions like the underlying medical issues, such as allergies, morning sicknesses, etc.,  to a partner, educational entity, or even an employer.

    Verifying a Pregnancy

    Most women tend to associate a missed menstrual period with a positive pregnancy test. However, this might not always be true, as missed menstrual periods might result from climatic changes or hormonal imbalances. Therefore, it is imperative that one verifies their pregnancy doubts by visiting a doctor or doing in-home tests as soon as possible after one missed period.

    A baby’s most important organs and structures develop during the first few weeks of pregnancy. For this reason, a woman should try as much as possible to verify a pregnancy claim early enough so that she can take the necessary steps to properly care for her unborn baby’s health.

    But, how does one verify pregnancy? Consult the following step-by-step guide to confirm a positive pregnancy claim to a partner, employer, or any other third party:

    Conduct a personal test

    Each time a sexually active woman misses their period, it is a first indication that something could be changing in the individual’s body. Given this case, it is best to visit a local pharmacy and procure a pregnancy test kit.

    The most widely used store-bought pregnancy test kits include:

    • Pregmate Pregnancy Urine Test Strips
    • ClinicalGuard HCG Pregnancy Test Strips
    • Clearblue Digital Pregnancy Test with Smart Countdown
    • First Response Early Result Pregnancy Test

    These are just some of the frequently used pregnancy testing kits. One can choose to buy a pregnancy testing kit that is readily available within their local stores. The above-mentioned pregnancy testing kits allow one to get results efficiently and are usually very affordable. Besides, they are almost 100% accurate, especially on the day of or after the woman’s expected menstrual period.

    Instead of using pregnancy testing kits, a woman can also use an In-Home test. Typical In-Home Tests include:

    • Testing pregnancy by placing urine in a cup and letting it sit overnight. If a thin white film forms at the top of the urine’s surface, there is a probability that the woman is pregnant. However, if the urine remains unchanged, then she is unlikely to be pregnant.
    • Pregnancy test using a sugar test- in this method, the lady should place urine in a cup then add 2-3 teaspoonfuls of white granulated sugar. Let the mixture sit for about 8-12 minutes. If the sugar clumps into small balls, it is a sign of a positive pregnancy result. However, if the sugar dissolves evenly, it is a negative pregnancy result.


    While most individuals prefer the privacy, convenience, and somehow quick results that In-home pregnancy test kits offer, they are not usually as accurate and reliable as blood tests done by a doctor or store-bought pregnancy test kits.

    Moreover, In-home pregnancy testing kits cannot determine if one’s pregnancy is developing as expected. Therefore, if an individual decides to use an in-home pregnancy test, it is advisable that the individual also visit a licensed medical practitioner for expert pregnancy advice.

    Plan an appointment

    After verifying the pregnancy, the first thing to do is schedule an appointment with a medical practitioner specializing in pregnancy issues and the well-being of an unborn baby. At the clinic/hospital, the local Obstetrician will conduct internal tests to ascertain if the woman is expectant or not. Such laboratory tests are usually conducted using a sample of blood and urine.

    These tests are very accurate as they not only detect the human chorionic gonadotropin (HCG), but they also indicate the amount of the hormone within the woman’s body, which typically doubles every 2-3 days during the first few weeks of the pregnancy phase. This means that a laboratory test by a doctor will inform the woman approximately how long she has been pregnant and essentially detect specific problems with the pregnancy if any. A pregnancy Lab test using blood is also essential as it helps to track the development of the pregnancy.

    Get verified

    Once the laboratory test is out, and the woman is confirmed to be pregnant, the local Ob/Gynae will issue her with the form. The form will contain the specific details of the pregnancy, such as any underlying health issues; complications, if any; expected delivery date, etc.

    The doctor will also record the following crucial information in the form:

    • The date the woman visited the clinic/hospital
    • The patient’s legal name
    • The estimated conception date based on the last menstrual period date
    • The age of gestation
    • The number of fetuses-whether twins, quadruplets, etc.
    • Additional information, if any
    • The doctor’s signature, title, official name, and phone number or email address.

    Pregnancy Verification Form Template

    Name ______

    Address _______________________________________________

    Contact No. ______

    To whomsoever, it may concern,

    The client, _ (Name) had conducted a pregnancy test in our presence. By our witness, we can confirm that her test, conducted on (Date of the test) has produced results that indicate a clear case of positive pregnancy. Based on vitals that include her menstruation period, blood patterns, and urine contents, we can estimate the date of delivery to be _ (estimated date of delivery.) Additionally, we also make the following observations;

    (Here, the physician may add any additional details.)



    Physician Name ______

    Hospital Name ______Date______

    Frequently Asked Questions

    What can be used as proof of pregnancy?

    Women who are pregnant may obtain a pregnancy verification letter from a licensed physician or hospital. They will have to take a pregnancy test with the doctor or nurse as a witness or submit blood and urine samples for verification in the hospital/clinic’s labs. Once the pregnancy status is confirmed, the doctor will issue a signed statement declaring that the woman is pregnant. This serves as legal proof of pregnancy.

    How do I show proof of pregnancy for Medicaid?

    As we mentioned earlier, a licensed physical or medical entity may issue a pregnancy verification letter. This will serve as adequate proof of pregnancy for Medicaid, as well as for any other legal purpose.

    Does Planned Parenthood give proof of pregnancy?

    Typically, Planned Parenthood conducts free pregnancy tests. If there is a doctor present at the clinic, they may agree to sign off on a proof of pregnancy form. Keep in mind that a witness will be required for such a form, meaning women may not take positive pregnancy tests that have been used earlier to obtain a proof of pregnancy verification letter.

    About This Article

    Rebecca Leaper
    Authored by:
    Attorney - Medical Malpractice, Contract Law, Family Law, Business Entity Formation, Professional Editor
    Rebecca Leaper seamlessly blends her roles as a mother, lawyer, and writer, bringing a rich tapestry of skills to her professional endeavors. As a seasoned litigator and appellate attorney, she possesses a keen eye for drafting, editing, and proofreading content. Her areas of legal mastery span from medical malpractice and family law to intricate contract drafting and appellate brief writing. Moreover, Rebecca's proficiency extends to forming both domestic and international business entities, including LLCs, corporations, and trusts. Alongside her legal expertise, she boasts project management skills and professional editing experience. Committed to excellence and precision, Rebecca is poised to collaborate on diverse projects, ensuring top-notch results.

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