Could Your Symptoms Be Hormone Related?

1
What are you hoping to improve? Select all that apply.
Energy and fatigue
Weight or metabolism
Mood and emotional well-being
Sleep quality
Mental clarity and focus
Sexual wellness or libido
Strength, muscle, poor recovery or injury from workouts, or physical performance
Hair or skin changes
Menstrual or menopause-related symptoms
Overall health and wellness
I'm not sure, I just don't feel like myself
Reproductive health
Urinary function
Joint health
2
Select any of the below symptoms you are currently experiencing. Select all that apply.
I often feel fatigued or have low energy, even when I've had enough sleep.
I've noticed changes in my mood, including increased irritability, anxiousness, or emotional ups and downs.
I've experienced unexplained weight changes or have more difficulty managing my weight than I used to.
I have difficulty falling asleep, staying asleep, or getting restful sleep.
I've noticed more difficulty concentrating, thinking clearly, or remembering things.
I've experienced a decrease in my sex drive or overall interest in intimacy.
I often wake up feeling tired of unrested, even after a full night of sleep.
I've noticed a decrease in my strength, muscle mass, or physical performance.
I've experienced increased hair shedding, thinning hair, or noticeable changes in body-hair growth.
I've noticed changes in my skin, such as increased dryness, oiliness, or breakouts.
None of these apply to me.
3
How long have you been experiencing these symptoms?
Less than 6 months
6-12 months
More than 1 year
I'm not sure
4
How significantly are these symptoms affecting your everyday life?
Somewhat
Moderately
Significantly
They're interfering with my day-to-day life.
5
Are you currently using any hormone-related medications or therapies?
Yes, I'm currently receiving hormone therapy.
I've used hormone therapy in the past, but not currently.
No, I've never used hormone therapy.
I'm not sure
6
What best describes what you're looking for right now?
I want to better understand what may be contributing to my symptoms.
I'm interested in having my hormone levels evaluated.
I'm interested in learning about available treatment options.
I'm already receiving treatment and would like another perspective.
7
If applicable, select any symptoms you're currently experiencing.
lrregular or unpredictable menstrual cycles
Heavy bleeding, painful periods, or severe cramping
Hot flashes, night sweats, or sudden warmth
Vaginal dryness, irritation, or discomfort
Mood changes related to my cycle or menopause
Decreased sexual desire or interest in intimacy
Waking at night feeling alert, restless, or anxious
None of these apply to me
8
Have you previously been diagnosed with a hormone-related or thyroid condition?
Yes, hormone-related only
Yes, thyroid-related only
Yes, both
No/ None of the above
9
If your symptoms and health history suggest that hormone optimization may be appropriate for you, how interested are you in discussing treatment options?
I'm ready to explore treatment options.
I'm interested, but i'd like more information first.
I'm mainly looking for information right now.
10
Our hormone care is provided through an ongoing annual program. How do you feel about concierge care?
An annual program works for me.
I'd like to learn more about what the program includes.
I'm not ready to commit to an annual program.
11
How would you prefer to take the next step?
I'm ready to sign up now!
Schedule a consultation
Learn more about the hormone program first.
Speak with someone from the team.
I'm not ready yet.
12
Name
First Name
Last Name
13
Email
example@example.com
14
Phone Number
Please enter a valid phone number.
15
Preferred contact method.
Text
Phone
Email
Should be Empty: