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PCOS Care Interest Form

*

Have you been formally diagnosed with PCOS?

Yes

No

Unsure — I have symptoms but no diagnosis

*

How long have you been experiencing symptoms?

A

Under 1 year

B

1–3 years

C

3–5 years

D

5+ years

*

Which symptoms are affecting you most? (select all that apply)

Irregular or absent periods

Weight gain

Fatigue

Acne

Hair loss

Excess hair growth

Mood changes

Fertility concerns

Other

*

Are you currently on any medication for PCOS?

A

Yes — please specify

B

No

C

I've tried medication before but stopped