Menopause Symptom Checklist

 

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Personal Details
Please double check you've entered the correct email address
Please note that you will need to remember this as it will be used to verify your identity at the start of the clinic
Menopause Symptoms

This can be used to monitor symptoms and is worth doing regularly to assess how symptoms change with time or with treatment

Please indicate the extent to which you are bothered at the moment by any of these symptoms

My total score: 

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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