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  • Hormonal Health Questionnaire

    At Elektra, we know first hand how confusing it can be to navigate hormonal health & menopause: 

    Are my symptoms normal?

    What is hormone replacement therapy? Is it safe? 

    What supplements or products can help with my [insert incredibly pesky symptom here]?

    To begin mapping your personal preferences & arm you with the information you need to discuss with a provider, we invite you to complete our Elektra Health "Hormonal Health Questionnaire." 

    Over the next 5-10 minutes, we'll ask you the questions & topics that we encourage every woman (and provider) to consider when developing a hormonal health treatment plan & strategy.

    Once completed, you'll receive a copy of your responses via email. We encourage you to use this document as a starting point & discussion guide with your provider to find the right solutions for you. 

    Ready to get started?

  • Before we move on: a note on privacy & security

    Elektra takes the security & privacy of our community members very seriously. To ensure your confidentiality, any personal information you share in this questionnaire is protected under our HIPAA-compliant policies & platforms.

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    Getting to Know You 

    At Elektra, we believe that health is a state of balance across one's physical, mental and emotional wellbeing. It's only when a provider understands the real you – who you are as an individual, your approach to health & what's important to you – that s/he can properly care for you. 





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    Define Your Goals

    No woman’s journey through hormonal health & menopause is the same. With that, let's discuss optimal health & wellness as you define it. 



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    How's Your Physical & Hormonal Health?

    Now that we know what's important to you about your health, let’s get specific around what's bothering you and how you’re feeling. We've highlighted some common menopause symptoms, but each woman's experience is unique -- if we've missed something, please do share!

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    How's Your Emotional Health? 

    Did you know 40% of perimenopausal women experience symptoms of depression and 57% of all menopausal women report mood swings?  Whatever your current emotional state, know that you're not alone. 

    Wherever you are in your journey, Elektra Health is here to listen & support you.

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    Medical History

    To build a hormonal health plan that truly fits your needs, it's important that your providers have a full picture of your personal & family health history & wellbeing. Read on for some of the key medical details your provider should know about you before recommending a specific course of treatment. 

  • Menstrual cycle

  • Surgeries, medications & more

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    Mailing address & submit

    Thanks for completing your online questionnaire & sharing your hormonal health story! Bring a copy of your questionnaire to your next doctor appointment to ensure you have more time to focus on solutions. Less admin, more action. 

    As a final step, please enter your mailing adress below so we can send you future Elektra treats by mail.

  • Click below to submit your questionnaire & return to the Elektra Health website.

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