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  • 31. BMI
  • 32. Have you ever tested positive for HIV?

  • 33. Have you previously had chicken pox or received the varicella (chicken pox) vaccine?

  • 34. Have you been vaccinated for MMR (measles, mumps, rubella)?

  • 35. Do you currently smoke cigarettes or use tobacco products? (Please note: medical screening of surrogates includes a nicotine test.)

  • 36. Were you ever a tobacco smoker? If yes, when and for how long?

  • 37. Do you have any history of smoking cigarettes or using tobacco products during any of your prior pregnancies? (NOTE: This will be verified on your medical records.)

  • 38. Do you currently use recreational drugs, including marijuana?

  • 39. Do you have a history of recreational drug use or alcohol abuse?

  • 40. Have you taken any anti-depressants, anti-psychotics, or anti-anxiety medications in the past six months?