Female Self Assessment Fill out the self assessment below and our team will reach out with more information! Mental Anxiety Brain Fog Depression Forgetfulness Irritability Lack of Focus Lack of Motivation/Drive Poor Memory Rapid Mood Swings Sleep Disturbances Physical Back/Body/Joint Pain Decreased Exercise Tolerance Dry Eyes Dry Skin Fatigue - Lack of Energy Heart Palpitations Lack of Motivation/Drive Loss of Muscle Tone Migraines/Headaches Night Sweats Osteoporosis/Osteopenia Restless Leg Syndrome (RLS) Thinning Hair Weight Gain (around midsection) Sexual Decreased Sexual Desire Difficulty Achieving Orgasm Hot Flashes Intense PMS Vaginal Dryness Name * First Name Last Name Email * Phone (###) ### #### Questions or Comments for our Medical Team Thank you!