JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Hormone Quiz
Take the quiz - your results will be emailed to you
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your full name
*
Your answer
1 point
Do you feel more emotional than normal?
1 point
Do you feel worn out and exhausted?
1 point
Do you have hot flashes?
1 point
Do you have night sweats?
1 point
Do you have bladder leakage when you cough, sneeze, or laugh?
1 point
Do you sometimes have brain fog?
1 point
Are you becoming forgetful?
1 point
Do you frequently feel panicked or anxious?
1 point
Do you have new mid-belly weight?
1 point
Do you have vaginal dryness or burning?
1 point
Do you have low sex drive?
1 point
Have you had an increase in migraines or headaches?
1 point
Has your menstrual flow been heavier than normal?
1 point
Is your menstrual bleeding longer than normal?
1 point
Have you had a new increase in menstrual cramps?
1 point
Do you have new Increased PMS?
1 point
Do you have new mid-sleep waking?
1 point
Are your menstrual cycles coming closer together?
1 point
Do you have new breast tenderness?
1 point
Have you gone more than 12 months without a cycle?
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Heather Isabel.
Report Abuse
Forms
