Female Hormone Quiz
Are you experiencing hot flashes?
Yes
No
Do you feel exhausted on a daily basis?
Yes
No
Do you suffer from headaches/migraines?
Yes
No
Do you suffer from night sweats?
Yes
No
Are you experiencing vaginal dryness?
Yes
No
Have you noticed loss of bladder control or frequent urination?
Yes
No
Are you noticing bouts of mild to severe depression?
Yes
No
Have you had a history of recent urinary tract infections?
Yes
No
Has there been an increase in forgetfulness?
Yes
No
Are you having trouble concentrating?
Yes
No
Have you noticed a decrease in your ability to explain things?
Yes
No
Do you suffer from occasional bouts of rapid heartbeat?
Yes
No
Are you more emotional?
Yes
No
Do you cry easily?
Yes
No
Back
Next
Are you noticing lumpiness in your breasts?
Yes
No
Are you experiencing anxiety?
Yes
No
Do you have irregular periods?
Yes
No
Do you become easily stressed?
Yes
No
Are you increasingly becoming moody with age?
Yes
No
Are you experiencing breakthrough bleeding?
Yes
No
Do you suffer from moderate ot severe menstrual cramps or PMS?
Yes
No
Do you have low body temperature?
Yes
No
Do you have or have a family history of endometriosis?
Yes
No
Do you suffer from sleep disturbances?
Yes
No
Do you have heavy periods?
Yes
No
Do you have joint or muscle pain?
Yes
No
Are you experiencing pain in multiple areas of your body?
Yes
No
Back
Next
Have you had an unexplained increase in weight?
Yes
No
Has your sex drive decreased?
Yes
No
Have you noticed increased belly fat?
Yes
No
Have you noticed an increase in the size of your breasts?
Yes
No
Are you developing cellulite?
Yes
No
Have you had a decrease in self esteem?
Yes
No
Do you feel like flopping onto the couch after work?
Yes
No
Are your eyelids drooping?
Yes
No
Have you noticed that your hair is thinning?
Yes
No
Do you feel hypersensitive?
Yes
No
Are you gaining weight?
Yes
No
Are your muscles turning to flab?
Yes
No
Do you have high triglycerides, high LDL & low HDL?
Yes
No
Do you have diminished Physical Performance?
Yes
No
Back
Next
First Name
*
Last Name
*
Email
*
Phone
*
What state do you reside in?
*
Please Select
What state do you reside in? *
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Other
International
Primary Health Concern
*
Please Select
Primary Health Concern *
Autoimmune
Diabetes
Digestive Health
Fatigue
Hormones
Thyroid
Mold/Environmental Toxicity
Nutrition and Diet
Pain & Inflammation
Sleep
Weight Issues
Womens Health
Mens Health
Childrens Health
Other
I agree the quiz results are for informational purposes only and not designed to diagnose or treat my specific conditions. I consent to be contacted by PriorityYou Health Center.
I agree the quiz results are for informational purposes only and not designed to diagnose or treat my specific conditions. I consent to be contacted by PriorityYou Health Center.
Submit
Should be Empty: