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Pregnancy Verification Form

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The pregnancy verification form is a letter that is used to show proof of a positive pregnancy test, confirming that the woman is indeed pregnant. The form details the date when the individual visited the clinic/hospital, the estimated date of delivery, and any additional notes or comments related to the test. This information is important as it helps to keep a record of the child’s development and can assist doctors in treating the individual for future visits.

How to Verify a Pregnancy

Use the following instructions to inform a partner of a positive pregnancy. If verified, the partner may still be able to dispute the claim it was him until either the baby is born or through other means while pregnant.

Step 1 – Conduct a Personal Pregnancy Test

If someone has missed their period, this is usually the first (1st) sign that something could be changing in a woman’s body. Especially, if a period has been missed. In this case, it’s best to go to the local pharmacy and pick up a pregnancy test.

Most Popular Testing Kits

Both testing kits are over 99% accurate and may be used up to five (5) days before a woman’s expected period date. Although, it’s more accurate on the day of or after the expected period date. Depending on where you purchase the test, it may cost anywhere from $8 to $20.

Most Popular In-Home Tests

  • Place Urine in a Cup – Let it sit overnight and if a thin white film covers the top of the surface then there is a good chance the woman is pregnant. If the urine stays the same then most likely she is not pregnant.
  • Sugar Test – Urinate in a cup and add 2-3 teaspoons of white granulated sugar (common sugar used for coffee). Wait 5-10 minutes and if the sugar clumps into small balls there is a good chance she is pregnant. If the sugar dissolves evenly, the woman is most likely not pregnant.

Step 2 – Schedule an Appointment

After a positive result, it’s best to schedule an appointment with your primary care physician or local OB/GYN. At the office, they will conduct their own internal tests which may be a combination of blood and urine.

Step 3 – Get Verified

During the appointment, if you test positive, the medical office will issue a pregnancy verification form (Download) that can be used to prove to any partner or third (3rd) party that the pregnancy is positive.

How to Write

Step 1 – Start by downloading the form in the format you prefer (Adobe PDF, Microsoft Word (.docx), Open Document Text (.odt)).

Step 2 – At the top of the form, use the empty spaces to enter the date of the pregnancy test (day, month, year) followed by the patient’s name.

Step 3 – Next, specify the estimated date of delivery (day, month, year).

Step 4 – Additional notes or comments may be entered in this section of the verification form.

Step 5 – In the remaining empty spaces, provide your signature, title, printed name, and phone number.


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