Take this free symptom checker form to help us understand how best to address your concerns. Once the form is submitted, one of our medical staff members will follow up at a time convenient to you. Female Health Assessment Name* First Last Email* Phone*When is it the best time to call?* What is your age? Symptom CheckerPlease check any symptoms that are issues you would like addressed.Vaginal Dryness Yes No Hot Flashes Yes No Night Sweats Yes No Insomnia- falling Asleep Yes No Insomnia- staying Asleep Yes No Anxious Yes No Depressed Yes No Irritable Yes No Mood Swings Yes No Foggy Thinking Yes No Poor Memory Yes No Feel Cold Yes No Dry Skin/Hair Yes No Diffuse Pattern Hair Loss Yes No Weight Gain/Inability to Lose Weight Yes No Loss of Energy/Fatigue Yes No Loss of Muscle Mass, Strength, or Tone Yes No Lack of Confidence Yes No Low Sex Drive Yes No Difficulty Reaching Orgasm Yes No Stress Yes No Loss of Motivation Yes No Feel Overwhelmed Yes No Sugar Cravings Yes No Craving Salty Foods Yes No Water Retention/Swelling Yes No Oily Skin/Acne Yes No Increased Facial Hair Yes No Please describe any other health concerns you may have or questions about services.Consent* I agree to the privacy policy.IMPORTANT: Your privacy and confidentiality are important to us. By submitting data to us and/or using our website, you give your consent that all personal data that you submit will be processed in the manner as described by the following Privacy Policy.NameThis field is for validation purposes and should be left unchanged.
