Pre-Consultation
Symptom Checker Questionnaire
Complete this checklist before your consultation. It helps your clinician understand your symptoms and provide the best possible care.
Symptom Checker
Do you have any of these symptoms of perimenopause (if you still have periods) or menopause (periods have stopped for over a year)?
0 of 22 answered
✓ Thank you. Your symptom checker has been submitted. Please bring this to your consultation.
| Symptoms | Y / N | Symptoms | Y / N |
|---|---|---|---|
| Heart beating quickly or strongly | YN |
Feeling dizzy or faint | YN |
| Feeling tense or nervous | YN |
Pressure or tightness in head | YN |
| Difficulty in sleeping | YN |
Parts of body feel numb | YN |
| Excitable | YN |
Headaches | YN |
| Attacks of anxiety, panic | YN |
Muscle and joint pains | YN |
| Difficulty in concentrating | YN |
Loss of feeling in hands or feet | YN |
| Feeling tired or lacking in energy | YN |
Breathing difficulties | YN |
| Loss of interest in most things | YN |
Hot flushes | YN |
| Feeling unhappy or depressed | YN |
Sweating at night | YN |
| Crying spells | YN |
Loss of interest in sex | YN |
| Irritability | YN |
Urinary or vaginal dryness symptoms | YN |
If you still have periods, how often are they? Are they heavy, light?
Use this space to note your main concerns or questions:
Ready to discuss your results?
Book a consultation and bring your completed symptom checker with you.
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