Do You Feel Tired with Reduced Energy and Muscle Strength?

Never Occasionally Regularly Very Often Constantly

1/20

Do You Experience Night Sweats or Excessive Sweating?

Never Occasionally Regularly Very Often Constantly

2/20

Are You Suffering from Hot Flashes?

Never Occasionally Regularly Very Often Constantly

3/20

Do You Suffer from Migraines or Headaches?

Never Occasionally Regularly Very Often Constantly

4/20

Do Your Hands and Feet Feel Unusually Cold?

Never Occasionally Regularly Very Often Constantly

5/20

Do You Have Frequent Urination or Loss of Bladder Control?

Never Occasionally Regularly Very Often Constantly

6/20

Have You Experienced Bouts of Mild to Severe Depression?

Never Occasionally Regularly Very Often Constantly

7/20

Do You Have Trouble Concentrating or Thinking Clearly?

Never Occasionally Regularly Very Often Constantly

8/20

Have You Noticed Episodes of Increased Forgetfulness?

Never Occasionally Regularly Very Often Constantly

9/20

Do you take long to learn new things or tasks?

Never Occasionally Regularly Very Often Constantly

10/20

Have You Experienced a Decrease in Your Ability to Explain Things?

Never Occasionally Regularly Very Often Constantly

11/20

Do You Become Easily Anxious, Nervous, or Stressed?

Never Occasionally Regularly Very Often Constantly

12/20

Do You Find Yourself Moody, Angry or Aggressive?

Never Occasionally Regularly Very Often Constantly

13/20

Do You Suffer from Sleep Disturbances?

Never Occasionally Regularly Very Often Constantly

14/20

Do you Experience Muscle or Joint Pain?

Never Occasionally Regularly Very Often Constantly

15/20

Have You Had Unexplained Weight Loss or Increase in Weight or Body Fat?

Never Occasionally Regularly Very Often Constantly

16/20

Are You Experiencing Decreased Sex Drive?

Never Occasionally Regularly Very Often Constantly

17/20

Are You Experiencing Hair Thinning?

Never Occasionally Regularly Very Often Constantly

18/20

Has Your Skin Become Dry or Wrinkled?

Never Occasionally Regularly Very Often Constantly

19/20

Do You Have Trouble Concentrating or Thinking Clearly?

Never Occasionally Regularly Very Often Constantly

20/20

Severity

Mild
Moderate
Severe
Very Severe

Score

1 - 20
21 - 40
41-60
61 - 80

Your symptoms and scoring suggest that you may be experiencing a hormone imbalance. Dont hesitate to reach out to our office for further evaluation.

You can call us at to schedule a consultation or we will reach out to you using the contact details provided.

Female Health Assessment

Hormone Assessment for Women

Choose which symptoms apply to you currently (in the last 2 weeks):

Do You Feel Tired with Reduced Energy and Muscle Strength?

Do You Experience Night Sweats or Excessive Sweating?

Are You Suffering from Hot Flashes?

Do You Suffer from Migraines or Headaches?

Do Your Hands and Feet Feel Unusually Cold?

Do You Have Frequent Urination or Loss of Bladder Control?

Have You Experienced Bouts of Mild to Severe Depression?

Do You Have Trouble Concentrating or Thinking Clearly?

Have You Noticed Episodes of Increased Forgetfulness?

Do you take long to learn new things or tasks?

Have You Experienced a Decrease in Your Ability to Explain Things?

Do You Become Easily Anxious, Nervous, or Stressed?

Do You Find Yourself Moody, Angry or Aggressive?

Do You Suffer from Sleep Disturbances?

Do you Experience Muscle or Joint Pain?

Have You Had Unexplained Weight Loss or Increase in Weight or Body Fat?

Are You Experiencing Decreased Sex Drive?

Are You Experiencing Hair Thinning?

Has Your Skin Become Dry or Wrinkled?

Do You Have Trouble Concentrating or Thinking Clearly?

Score:

Severity

Score

Are you experiencing any pain?

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