| I do not have regular Pap tests (a test used to detect both dysplasia and cervical cancer) | YES | NO |
| Do I have many sexual partners or a sexual partner who has had many partners? | YES | NO |
| Do I have a weakened immune system (for example, from taking drugs after an organ transplant or having a disease such as AIDS)? | YES | NO |
| Have I used birth control pills for a long time? | YES | NO |
| Have I given birth to many children? | YES | NO |
| Was my last Pap test more than two years ago? | YES | NO |
| Am I sexually active or have I ever had sex? | YES | NO |
| Do I have a history or a diagnosis of HPV? (Human Papilloma Virus) | YES | NO |
| Am I a smoker? | YES | NO |
| Was I sexually active at a young age? | YES | NO |
| Have I taken diethylstilbestrol (DES) or being the daughter of a mother who took DES (a form of estrogen that was used between 1940 and 1971 to treat women with certain problems during pregnancy, such as miscarriages) | YES | NO |