Answer the questions below. If you answer Yes to 3 or more, a free consultation with our specialists is recommended.

Q1. Energy Levels: Do you experience fatigue throughout the day?

YesNo

Q2. Sleep Quality: Are you having trouble with sleep, either falling asleep or staying asleep at night?

YesNo

Q3. Concentration: Do you have trouble with focus, or find it difficult to complete tasks?

YesNo

Q4. Weight Gain: Have you noticed recent weight gain, particularly around your stomach, hips, and thighs?

YesNo

Q5. Menstrual Cycles: Are your menstrual cycles becoming shorter or more irregular?

YesNo

Q6. Sexual Desire: Has your interest in sex decreased lately?

YesNo

Q7. Vaginal Discomfort: During intercourse, do you experience vaginal dryness or discomfort?

YesNo

Q8. UTIs: Are you prone to frequent urinary tract infections?

YesNo

Q9. Mood Changes: Have you noticed yourself feeling more irritable or experiencing mood swings recently?

YesNo

Q10. Stress Management: Do you feel overwhelmed, or unable to cope with stress effectively?

YesNo

Q11. Reduced Interest & Anxiety: Have you lost interest in activities you used to enjoy, or feel anxious or down more often?

YesNo

Q12. Facial Hair Growth: Have you noticed any increase in unwanted facial hair?

YesNo

Q13. Hair Loss: Are you experiencing hair thinning or loss?

YesNo

Q14. Hot Flashes: Do you experience hot flashes throughout the day?

YesNo

Q15. Night Sweats: Do you frequently wake up in the middle of the night sweating?

YesNo

Q16. Joint Pain & Recovery: Have you noticed more aches and pains in your joints, or are you taking longer to recover after exercise?

YesNo

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Medical Disclaimer. This health assessment is provided for informational and educational purposes only. It does not constitute medical advice, diagnosis, or treatment, and is not a substitute for consultation with a licensed healthcare provider. Your responses are used only to help our team prepare for your free consultation. If you are experiencing a medical emergency, call 911. By submitting this form you consent to be contacted by Progressive Health & Rejuvenation.

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