Hormone Assessment Intro | West Chester BeBalanced Hormone Weight Loss Centers

Step 1 of 6 - Intro

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Choose one of the options below. Are you... * Required
- Pre-Menopausal
- Peri-Menopausal
- Post-Menopausal
- None of the above [male]
Having regular monthly periods
Still having periods, but something is different
12 months with no cycle or hysterectomy
Do you feel like you want to lose weight? * Required
- Yes
- No

Does your period lead to any of the following symptoms? To help us guide you, please click all that apply.
- Menstrual cramps
- Irritability
- Mood swings
- Heavy or irregular periods
- Feeling anxious
- Feeling depressed
- Can’t turn your mind off
- Breast tenderness
- Headaches
Does your period lead to any of the following symptoms? To help us guide you, please click all that apply.
- Heavy or irregular periods
- Night sweats or hot flashes
- Insomnia
- Feeling anxious
- Feeling depressed
- Can’t turn mind off
- High blood pressure
Do you have any of the symptoms related to menopause or post-menopause? Click all that apply.
- Night sweats or hot flashes
- Insomnia
- Feeling anxious
- Feeling depressed
- High blood pressure
- Headaches or migraines
Do you have any of these symptoms? Click all that apply.
- Insomnia
- Feeling anxious
- Feeling depressed
- Can't turn mind off
- Aggressive/Moody
- High blood pressure
- Enlarged Prostate
- Hair on shoulders and/or back

Do you have any symptoms that may relate to insulin or low blood sugar? Click all that apply.
- Shakiness
- Hunger
- Fatigue
- Stubborn weight or recent weight gain around waist
- Sweet or salty cravings
Do you have any symptoms that may relate to insulin or low blood sugar? Click all that apply.
- Shakiness
- Hunger
- Fatigue
- Stubborn weight or recent weight gain around waist
- Sweet or salty cravings
Do you have any symptoms that may relate to insulin or low blood sugar? Click all that apply.
- Insulin resistance/diabetic
- Stubborn weight or recent weight gain around waist
- Sweet or salty cravings
Do you have any symptoms that may relate to insulin or low blood sugar? Click all that apply.
- Shakiness
- Hunger
- Fatigue
- Insulin resistance/diabetic
- Stubborn weight or recent weight gain around waist
- Sweet or salty cravings
- Gynecomastia (Male breast tissue development)

Do you have a symptom like low energy that may relate to your thyroid? Click if so.
- Low energy daily
Do you have any symptoms that may relate to lowered estrogen? Click on all that apply.
- Lack of Libido
- Vaginal dryness
Do you have a symptom that may relate to your thyroid? Click all that apply.
- Low energy daily
- Hair loss/male pattern balding

Has a doctor diagnosed you with any of these conditions? Click on all that apply.
- Chronic fatigue or fibromyalgia
- Endometriosis or fibroids
- Ovarian tumor or cysts

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ZIP Code: * Required
Phone: * Required
How did you hear about us? * Required
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© 2021 West Chester BeBalanced Hormone Weight Loss Centers. All Rights Reserved

Call: 1-844-980-1010

Call: 1-844-980-1010