“I don’t want to go.” I sometimes feel low and lose interest in my life for no reason at all.
*
Not at all
A little
Some
A lot
All the time
“I feel like I am in a fog.” Starting towards the end of the day you can’t think straight.
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Not at all
A little
Some
A lot
All the time
“I used to like sex, now I can just take it or leave it.” Does this bother you?
*
Not at all
A little
Some
A lot
All the time
“I’m so tired all the time, but I just can’t sleep.” Does this sound like you?
*
Not at all
A little
Some
A lot
All the time
No matter what I do, how much I exercise or how little I eat, I just keep gaining weight.
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Not at all
A little
Some
A lot
All the time
“When I do finally fall asleep, I have terrible night sweats and it’s disgusting.” Does this happen to you?
*
Not at all
Only once
2-5 times
More than 5 times
“Oh, the hot flashes!” Do you seem to get hot at the most unusual and sometimes embarrassing times?
*
Not me
Yeah, once in a while
Definitely
PLEASE! Make them stop!
Almost done!
While we crunch the numbers, where should we send you the results?
First Name
*
Last Name
*
Phone
*
Email
*