START QUESTIONS HERE Answer the questions below so we know more about what's causing your problems. Leave Blank if You Don't Have the SymptomFatigue Severe Moderate Mild Fatigue after eating Severe Moderate Mild Bloating after eating Severe Moderate Mild Afternoon crash Severe Moderate Mild Difficulty falling asleep Severe Moderate Mild Difficulty staying asleep Severe Moderate Mild Anxiety Severe Moderate Mild Depression before menstruation Severe Moderate Mild Coated tongue (white film) Severe Moderate Mild History of birth contol pills Severe Moderate Mild History of antibiotics Severe Moderate Mild Headaches or migraines Severe Moderate Mild Constipation Severe Moderate Mild Vaginal itch Severe Moderate Mild Vaginal dryness Severe Moderate Mild Hot flashes Severe Moderate Mild Night sweats Severe Moderate Mild Acne before or during menstruation Severe Moderate Mild Heavy bleeding during menstruation Severe Moderate Mild Painful uterine cramping Severe Moderate Mild Recurrent urinary tract infections Severe Moderate Mild Difficulty with conception- Infertility Severe Moderate Mild PMS Severe Moderate Mild Irregular cycles Severe Moderate Mild Ovarian cysts Severe Moderate Mild Fibroids Severe Moderate Mild Joint pain Severe Moderate Mild Almost Done! Please provide information about your most important health problem.Describe your most important health problem below.How long ago was the VERY FIRST time you can recall having this problem?What have you done so far to try to fix this problem?Overall, is this problem tending to: Improve Stay the same Get worse Is there anything else you feel would be important to know about your health?First NameYour agePhoneZip Code (Required)You'll Schedule Your Call on the Next Screen Δ
