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Hormone Evaluation Form

Please fill out our evaluation form which will help us evaluate your medical history and how we can help you achieve hormone harmony.  You can either fill out the online form or print out this PDF and fill it out with your doctor.

These questions will help us evaluate:

  • Your hormone balance
  • What symptoms you are suffering from
  • What you want to achieve from hormone replacement therapy

The application of hormone replacement therapy can include all hormones for people of all ages with different habits and all possible schedules of replacement. Hormone balances are specific to your personal history and individual tolerance, with side effects from too little or too much hormone. Your symptoms tell us how your body handles the hormones you make, which ones are deficient, and why you started having certain problems.

We will work with you and your doctor to achieve the best results.