• Women’s Health & Hormone Care Intake

    Share your health and hormone background to get started.
  • Welcome to Simone RX Personalized care for your hormonal health — supporting balance, comfort, and long-term wellness. At Simone RX, we provide convenient provider-led virtual care for women's health and hormone concerns through a streamlined telehealth experience designed around comfort, privacy, and personalized treatment support. Our services may help with birth control management, hormone therapy, menopause and perimenopause care, PCOS-related concerns, and other hormonal health needs — with a focus on safe, evidence-based treatment tailored to your needs. Most intakes take approximately 5–10 minutes. ✔ Personalized provider-led women's health care ✔ Birth control & hormone therapy management ✔ Menopause & perimenopause support ✔ Convenient, private virtual care
  • Format: (000) 000-0000.
  • Preferred Communication*
  • What would you like help with today? (Check all that apply)*
  • How long have you been experiencing your current concern?*
  • How would you describe your cycles?*
  • Are you currently pregnant, breastfeeding, or trying to conceive?*
  • Current contraception (check all that apply)*
  • Are you experiencing any of the following? (Check all that apply)*
  • Have your symptoms recently worsened?*
  • Do you have, or have you ever had, any of the following? (Check all that apply)*
  • Medication Allergies*
  • Have you previously used hormonal treatments? (Check all that apply)*
  • Are you requesting a medication refill?*
  • Records Upload (Optional) — Recent labs or medical records help your provider. Accepted formats: PDF, JPG, PNG. Max 10MB per file.
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  • Upload a File
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  • Format: (000) 000-0000.
  • Consent & Acknowledgment
    Please review and acknowledge the following statements. All five boxes must be checked to submit your intake.
  • I acknowledge the following statements*
  • Thank You for Your Interest
    Simone RX currently serves patients in Georgia, California, and New Hampshire. We've recorded your interest and will reach out when we expand to your state. For urgent care needs, please contact your local provider.
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