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Self Assessment of Hormone Imbalances

This self-assessment is designed to help you determine if your symptoms could possibly be due to hormone imbalances.

Full Name*

Email*

Phone

Date of Birth

Please check off the boxes that apply to you.

Do you have or have you experienced any of these symptoms in the past 6 months……

Low Testosterone

Lack of Interest in Sex

Decreased sexual satisfaction

Lack of confidence and competitive drive

Decreased Motivation (feeling blah)

Harder time making decisions

Decreased muscle tone

Loss of bone density

Excess Testosterone

Excess hair on your face, chest, or arms

Acne

Greasy skin and/or hair

Discoloration of your armpits (darker and thicker than your normal skin)

Skin tags, especially on your neck and upper torso

Reactivity and/or irritability, or excessively aggressive or authoritarian episodes

Midcycle pain

Ovarian cysts or Polycystic ovary syndrome

Hyperglycemia or hypoglycemia and/or unstable blood sugar

IF you answered moderate to high to most symptoms you are most likely experiencing hormone imbalance.

Thank you for your time in completing this self-assessment. Please feel free to submit your symptom self-assessment to our clinic by hitting the submit button below. Dr. Sidhu can review this with you during your initial consultation and help you discover the most suitable therapy for your needs to help you get back to feeling your best again.

After clicking the submit button, a new window will pop up, providing you with the option to request an appointment.

This self-assessment is designed for informational purposes only and does not substitute for a professional medical diagnosis.

Please verify your request.*