Are Your Hormones Out of Balance?

Take This Quiz to Find Out

Symptoms Checklist *

I feel tired or drained, even after sleeping

I have low sex drive or difficulty with arousal

I feel irritable, moody, or anxious for no reason

I’ve noticed weight gain around my belly

My sleep is poor or interrupted

My memory or focus has declined

I get hot flashes or night sweats

I’ve lost interest in intimacy or feel emotionally flat

I feel like I’m “just not myself” anymore

Lifestyle + History

Age Group *

Have you had your hormone levels checked before? *

Yes

Are you currently using: *

Birth control pills

HRT (Estrogen or Progesterone)

Nothing currently

Goals & Motivation

Are you open to natural/bioidentical hormone therapy if it helps? *

Yes

Not sure

Contact Info

Full Name *

Email *

Phone *

Zip Code *

Preferred time for a consult or call

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