To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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You can select more than one option
Vaginal dryness and discomfort
Flushes that are extremely hot
Sweats at night
Headaches
Mood swings
Problems with sleep
Palpitations
None of the preceding




If you answered yes, could you kindly inform us if your symptoms have improved?

Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Please provide more information of the medication being used if any.


Please select your option
Presently Pregnant
Presently Breastfeeding
Planning on getting pregnant
Neither Pregnant nor Breastfeeding

Please select your option
Male
Female
Transmale (Born a female)
Transfemale (Born a male)



If you have, please tell us the HRT treatments you've tried and how long you've been using them.



If you answered yes, could you kindly inform us if your symptoms have improved?

Especially womb, breast, ovary, uterial or cervical cancer?

Vaginal bleeding that is abnormal.
Gallstones problems
Diabetes condition
Migraines
Blood pressure that is too high.
A blood clotting disease, often known as a blot clot.
Porphyria
Breast issues

You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function