0 Likes2,053 Views0 Welcome to Hormone Balance Evaluation for WOMEN! We are about to ask you a few simple questions to help us estimate how balanced your key hormones may be. Let's get started! How is your Energy Level?Like an Energizer BunnyTired but enough to get through the dayToo tired after work for anythingBarely make it through the day How is your mood? Happy-go-lucky most of the timeEven, neither bad nor goodMood siwngs, ups and downsSad and depressed a lot How is your mental sharpness? I am pretty sharp, no complaintsI think I used to be smarterIt's getting harder to keep up with othersConstant brain fog. I've never been like that! Do you get hot flashes and/or night sweats?NeverOccasionallyRegularly (once a week or less)Frequently (more than once a week) How is your sex drive?Same I had for yearsOK but less than what it used to be 5 years agoDefinitely decreasedNonexistent How is your sleep?Good, I feel fully rested in the morningI sleep every night but don't feel it's enoughI have trouble falling asleep, wake up oftenIt's a constant struggle; I feel exhausted in the morning How often you feel cold without a reason?NeverSometimesOftenConstantly: I never seem to be able to get warm Losing hair or brittle hair?Nothing unusualIt's getting noticeably worseI am beginning to really worry about my hair loss and breakageIt's a disaster! My hair is falling out every day! Skin getting dry and/or winkled?Nothing beyond what I consider normal for my ageMore than I am willing to accept but nothing seriousI think my skin is beginning to look much older than my ageThe way my skin looks is really worrisome, and it's only getting worse. How are your body weight and shape?I haven't noticed any recent changes in my weight or the way I lookI've gained a few pounds but in "all the right places"I've gained quite a few pounds especially around midsectionI've gained a lot of weight and my body shape has changed a lot (big belly, smaller hips, batwings, etc.) What is your age?18-3536-4546-5556 + That's it! To ensure privacy, we'll send you results via email. Your First Name Your Email I agree to receive the results of this evaluation and other communication from CT Hormone Therapy and Integrative MD via email. Time is Up!