Female Health Assessment

Empower Yourself: Begin the Assessment

Many individuals face the challenges of hormonal imbalances without realizing there are alternative solutions. Taking this assessment is your first step toward making informed choices. Let us know if you've been experiencing any of the following symptoms, and together, we'll explore the right path for your well-being.

Take The Female Health Assessment Survey

First Name

Last Name

Phone *

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Symptoms

Please mark the appropriate box for each symptom you may be experiencing.

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

Decline in drive or interest (loss of “zest for life,” feeling down or sad)

Vaginal dryness or difficulty with sexual intercourse

Difficulties with memory (concentration, finding the right word, or retaining information)

Sweating (night sweats or increased episodes of sweating)

Irritability (mood swings, feeling aggressive, angers easily)

Sleep Problems (difficulty falling asleep or sleeping through the night)

Feeling cold all the time, having cold hands or feet

Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

Weight (difficulty losing weight despite diet/exercise)

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

Sexual Problems (change in desire, activity, orgasm and/or satisfaction)

Hair loss, thinning or change in texture of hair

Hot Flashes (burst that starts in chest and lasts for short duration)

Headaches or migraines (increase in frequency or intensity)

Other symptoms or unique health circumstances to take into consideration:

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