Women's Questionnaire

Do you have hot flashes?

Yes

No

Do you have a lack of energy, or have your
energy levels decreased?

Yes

No

Do you have restless sleep
or sleep disturbances?

Yes

No

Are you falling asleep after dinner?

Yes

No

Have you noticed a decreased
enjoyment of life?

Yes

No

Are you moody or easily irritated?

Yes

No

Do you have difficulty concentrating, or
have short-term memory loss?

Yes

No

Have you noticed muscle loss?

Yes

No

Do you have excess body fat?

Yes

No

Have you experienced low libido
and/or pain during intercourse?

Yes

No

What’s your name, email and phone number?

Once you provide this information, we’ll calculate your results.

* denotes a required field.