Bioidentical Hormone Replacement Therapy
Hot flashes, sweating (episodes of sweating)
Heart discomfort (unusual awareness of heart beat,heart skipping, heart racing, tightness)
Sleep problems (difficulty in falling asleep, difficulty in sleeping through the night, waking up early)
Depressive mood (feeling down, sad, on the verge of tears,lack of drive, mood swings)
Irritability (feeling nervous, inner tension, feeling aggressive)
Anxiety (inner restlessness, feeling panicky)
Physical and mental exhaustion (general decrease in performance,impaired memory, decrease in concentration, forgetfulness)
Sexual problems (change in sexual desire,in sexual activity and satisfaction)
Bladder problems (difficulty in urinating, increased need to urinate,bladder incontinence)
Dryness of vagina (sensation of dryness or burning in the vagina,difficulty with sexual intercourse)
Joint and muscular discomfort (pain in the joints,rheumatoid complaints)
Do you have cold hands or feet?
Do you have daily bowel movements?
Do you have gas bloating or abdominal pain after you eat?
Please select your level of activity based off of this critiera (activity that raises your heart rate/breathlessness)
Please provide your information below so a member of our team can contact you.
Decline in your feeling of general well-being(general state of health, subjective feeling)
Joint pain and muscular ache (lower back pain, joint pain,pain in a limb, general back ache)
Excessive sweating (unexpected/sudden episodes of sweating,hot flushes independent of strain)
Sleep problems (difficulty in falling asleep difficulty in sleeping through,waking up early and feeling tired, poor sleep, sleeplessness)
Increased need for sleep, often feeling tired
Irritability (feeling aggressive, easily upset about little things, moody)
Nervousness (inner tension, restlessness, feeling fidgety)
Anxiety (feeling panicky)
Physical exhaustion / lacking vitality (general decrease in performance,reduced activity, lacking interest in leisure activities, feeling of getting less done,
of achieving less, of having to force oneself to undertake activities)
Decrease in muscular strength (feeling of weakness)
Depressive mood (feeling down, sad, on the verge of tears, lack of drive,mood swings, feeling nothing is of any use)
Feeling that you have passed your peak
Feeling burnt out, having hit rock-bottom
Decrease in beard growth
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Decrease in ability/frequency to perform sexually
Decrease in the number of morning erections
Decrease in sexual desire/libido (lacking pleasure in sex,lacking desire for sexual intercourse)
Do you have cold hands and feet?
Do you have gas, bloating or abdominal pain after eating?
Please select your WEEKLY Activity Level based on this criteria ➔ Physical activit y that accelerates heart rate / Breathlessness
Leave your contact information below so a member of Halo Health and Wellness may contact you.
