Divine naturopathic clinic & wellnes center lorgo

Home
Begin Your Care
- Book an Appointment
- Hormones Evaluation Quiz
Patients Portal
Services
About us
Contact

Empower Yourself: Begin Your Assessment

Comprehensive hormone evaluations designed to uncover imbalances and support your well-being at every stage of life.

Take The Female Health Assessment Survey

Female Health Assessment

First Name

Last Name

Email *

Phone *

Symptoms

Please mark the appropriate box for each symptom you may be experiencing.

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Decline in drive or interest (loss of “zest for life,” feeling down or sad)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Vaginal dryness or difficulty with sexual intercourse

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Difficulties with memory (concentration, finding the right word, or retaining information)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sweating (night sweats or increased episodes of sweating)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Irritability (mood swings, feeling aggressive, angers easily)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sleep Problems (difficulty falling asleep or sleeping through the night)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Feeling cold all the time, having cold hands or feet

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Weight (difficulty losing weight despite diet/exercise)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sexual Problems (change in desire, activity, orgasm and/or satisfaction)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Hair loss, thinning or change in texture of hair

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Hot Flashes (burst that starts in chest and lasts for short duration)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Headaches or migraines (increase in frequency or intensity)

Choose One

None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Other symptoms or unique health circumstances to take into consideration:

By providing your phone number, you agree to receive text messages from Divine Naturopathic Clinic for appointment details and other informational text messages. Message and data rates may apply. Message frequency may varies.

Feeling Great Has Never Been Easier!

We are excited to meet you and help you feel your best.

BOOK AN APPOINTMENT

Only takes a few seconds

About Us

Personalized naturopathic medicine to restore balance, enhance vitality, and support natural wellness.

Address: 1715 Market Street, Suite 103, Kirkland, WA 98033

Phone: 425 785 1913

Hours of Operation:
Monday- Friday
9:00 am- 5:00 pm