Female Hormone Quiz

1

2

Do you have excess or unwanted facial or body hair?

YESNO

3

Do you experience scalp hair loss or hair thinning?

YESNO

4

Do you have acne?

YESNO

5

Do your cycles vary?

YESNO

6

Do you experience fatigue and sugar cravings after meals?

YESNO

7

Do you feel drops in energy in the afternoon?

YESNO

8

Have you noticed increased weight gain and difficulty losing weight?

YESNO

9

10

Do you experience painful periods (pelvic pain and cramping) before and/or several days into your menstrual cycle?t?

YESNO

11

Do you experience pain with intercourse?

YESNO

12

Do you experience abnormal menstruation or spotting?

YESNO

13

Do you experience pain with bowel movements or urination?

YESNO

14

Chronic digestive complaints?

YESNO

15

Score

16

Have you ever been diagnosed with an autoimmune disease?

Yes

No

17

Your Score is {typeA}/35

18

Are you looking for a new approach to your health?* This field is required.

Yes

No

19

Where should we send the results?* This field is required.

example@example.com

20

Name* This field is required.

First Name

Last Name

21

Phone Number* This field is required.

Area Code

Phone Number