top of page

Female Health Assessment

Please click the appropriate circle to rate the following symptoms that apply to you within the past 2-4 weeks. Once completed, submit form and someone in our office will respond to let you know if you might be a good candidate for BioTe pellets!
Hot flashes
Sweating (night sweats or increased episodes of sweating).
Sleep problems (falling or just staying asleep).
Depressive mood (feeling down, sad, on the verge of tears, lack of motivation).
Irritability (mood swings, feeling aggressive, angers easily).
Anxiety (inner restlessness or tension, feeling nervous or panicky).
Physical exhaustion (decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy or stamina).
Sexual problems (decrease in sexual desire, sexual activity, orgasm and/or satisfaction).
Bladder problems (difficulty urinating, increased need to urinate, incontinence).
Vaginal symptoms (sensation of dryness or burning, difficulty or discomfort with sexual intercourse).
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise).
Difficulties with memory.
Problems with thinking, concentrating, or reasoning.
Difficulty learning new things.
Trouble thinking of the right word to describe persons, places, or things when speaking.
Increase in frequency or intensity of headaches or migraines.
Hair loss, thinning, or change in texture of hair.
Feel cold all the time or have cold hands or feet.
Weight gain or difficulty losing weight despite diet and exercise.
Dry or wrinkled skin.

Thanks for your submission!

bottom of page