COULD YOUR SYMPTOMS BE HORMONE RELATED?

1. Have you been feeling more tired or fatigued than usual? *

Yes

No

2. Have you noticed weight gain or difficulty losing weight? *

Yes

No

3. Have you experienced decreased motivation or low energy? *

Yes

No

4. Have you had trouble sleeping or staying asleep? *

Yes

No

5. Have you noticed mood changes, irritability, or anxiety? *

Yes

No

6. Have you experienced brain fog or difficulty concentrating? *

Yes

No

7. Have you noticed decreased libido or changes in sexual wellness? *

Yes

No

8.Have you experienced reduced muscle tone or strength? *

Yes

No

9.Do you often feel “off” but cannot pinpoint why? *

Yes

No

10. Have your symptoms affected your daily quality of life? *

Yes

No

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