Have you ever taken hormone therapy before?

Have you Ever Had an Abnormal Pap Smear?

Have you Ever Had a Breast Biopsy?

Have you Ever Had a Cervical Biopsy?

Have you had any recent changes in your breast tissue that has not already been evaluated by your Ob/Gyn?

Are you Still Having a Menstrual Cycle?

Do you have a history of Any of the Following Cancers?

Do you have any symptoms listed here that could indicate Estrogen Deficiency?

Do you have any symptoms listed here that could indicate Estrogen Excess or Progesterone Deficiency?

Do you have any symptoms listed here that could indicate Androgen Excess?

Do you have any symptoms listed here that could indicate Androgen Deficiency?

Do you have any symptoms listed here that could indicate Adrenal Insufficiency or Excess?

Do you have any symptoms listed here that could indicate Thyroid Excess?

Do you have any symptoms listed here that could indicate Thyroid Deficiency?

What medical problems do you have?

Medication Allergies

Family History

Tobacco Use

Illicit Drug Use

Alcohol Use

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