Menopause Group Clinic Self-Referral Form Logo
  • Menopause Virtual Group Consultation Self-Referral Form

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  • Questionnaire

    Before you can attend a group clinic, the clinician needs the following information from you. The clinician and facilitator of the group will be able to access your answers to provide you with care.
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  • Symptom Checker

    To help us with your assessment please indicate the extent in which you are affected by the following symptoms. Please tick as appropriate.
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  • Video group clinic registration and agreement:

    By participating in this group clinic I agree to the following:
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  • Should be Empty: