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  • Pre-screening Form

  • Please not that due to provincial licensing regulations, we can only see patients who are residents of Alberta. Which province or territory in Canada are you a resident of?*

  • At this time, Cycles to Cessation is only funded to provide care to residents of Alberta. Please check local resources for available menopause treatment options.

    Thank you for completing the survey.
    Unfortunately, you do not meet the eligibility criteria for virtual care at this time.

    We understand this may feel frustrating. Your experience helps highlight the need for better, publicly funded women's health services in Alberta. If you'd like to support this work, please visit our website and explore the Advocacy section to learn how we can push for improved access to women's health care together.

  • Will you physically be in Alberta at the time of your appointment?*

  • Our clinic can only provide virtual care to patients who are in Alberta at the time of their appointment. Because you will not be in Alberta, we're unable to offer you care through this program.

    Thank you for completing the survey.
    Unfortunately, you do not meet the eligibility criteria for virtual care at this time.

    We understand this may feel frustrating. Your experience helps highlight the need for better, publicly funded women's health services in Alberta. If you'd like to support this work, please visit our website and explore the Advocacy section to learn how we can push for improved access to women's health care together.

  • Participation in our program requires patients to have a computer, tablet, or phone with a working camera. Will you have access to a device with a working camera?*

  • Our clinic visits are provided by secure video. Because you will not be using a device with a camera, we're unable to safely see you through our program.

    Thank you for completing the survey.
    Unfortunately, you do not meet the eligibility criteria for virtual care at this time.

    We understand this may feel frustrating. Your experience helps highlight the need for better, publicly funded women's health services in Alberta. If you'd like to support this work, please visit our website and explore the Advocacy section to learn how we can push for improved access to women's health care together.

  • I am currently between 40 and 60 years of age.*

  • Our clinic is designed to support people in perimenopause and menopause, which most often begins around age 40 through to age 60. We understand that symptoms can sometimes start earlier than 40 or continue beyond 60, however in these age groups, further tests or in-person examinations are usually needed to provide safe care. Because of this, virtual care through our program would not be the safest choice for you.

    Thank you for completing the survey.
    Unfortunately, you do not meet the eligibility criteria for virtual care at this time.

    We understand this may feel frustrating. Your experience helps highlight the need for better, publicly funded women's health services in Alberta. If you'd like to support this work, please visit our website and explore the Advocacy section to learn how we can push for improved access to women's health care together.

  • I confirm that the information I have provided in this form is accurate and complete to the best of my knowledge. I understand that providing incomplete or incorrect information may affect my safety and could lead to significant risks, especially if treatment including hormone therapy, is based on inaccurate details.

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