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Have you experienced any of the following symptoms recently? Please circle the number that best describes your experience.
Food Cravings
Yes
No
Fatigue
Yes
No
Hot Flashes
Yes
No
Night Sweats
Yes
No
Weight Gain
Yes
No
Dry Hair
Yes
No
Dry Skin
Yes
No
Hair Loss
Yes
No
Breast Tenderness
Yes
No
Fibrocystic Breasts
Yes
No
Heart Palpitations
Yes
No
Bloating
Yes
No
Bladder Symptoms
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No
Frequent UTI or Incontinence
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Painful Intercourse
Yes
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Vaginal Dryness
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No
Arthritis/Joint Pain
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No
Fluid Retention
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No
Foggy Brain/Fuzzy Thinking
Yes
No
Headaches
Yes
No
Anxiety
Yes
No
Depression
Yes
No
Irritability
Yes
No
Inability to Concentrate
Yes
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Mood Swings
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PMS
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Nervousness
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Poor Sleep
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Decreased Sex Drive
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Harder to Reach Climax
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Δ
Dr. Novlet Davis,
"Dr. D"
Licensed Physician & Autism Specialist
Steven N. Hannant
,
“Dr. Steve”
PsyD, MSCP, Clinical Psychologist
Learn More
Regan L. Hannant
MSW, LCSW
Psychotherapist
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