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MENO QUESTIONNAIRE

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Hello and thank you for contacting me for a 30 minutes evaluation session.

I hope to be able to speak with you soon. To make our evaluation session as productive as possible, please check the boxes that correspond to your case.

Talk to you soon!
Tara

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Which of the following symptoms are bothering you right now?*

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Constipation

Flatulance

Hot Flashes

Night Sweats

Sore Breasts

Heartburn

Interrupted Sleep

Irritable Bowel Syndrome (IBS)

Tension / Premenstrual Syncrome

Painful Periods

Heavy Periods

Very Light Periods

Irregular Periods

Endometriosis

Fibroids

Ovarian Cysts

Loss of Libido

Heart Palpitations

Vaginal Dryness

Mood Swings

Joint Pain

Sugar Cravings

Anxiety

Fatigue

Exhaustion

Memory Lapses

Difficulty Concentrating

Hairloss

Weight Gain

Dizziness

Bladder Incontinence

Anal Incontinence

Vaginal Prolapse

Osteoporosis

Osteopenia

Panick Attacks

Depression

Which three symptoms are bothering you MOST right now?

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Thank you very much for filling in this form. Please submit and choose a date and time for your 30 Minutes Discovery Session.