INSTRUCTIONS: Please answer the following questions with none, mild, moderate, severe, or extremely severe. Your answers will help you to better understand the severity of your hormonal imbalance if an imbalance exists.
Are you experiencing the following symptoms?
- Decline in your feeling of general well-being (general state of health, subjective feeling)
- Joint pain and/or muscle aches (lower back pain, joint pain, pain in a limb, general increase in aches and pains)
- Excessive sweating (unexpected/sudden episodes of sweating, hot flushes independent of your activity level)
- Sleep problems (difficulty in falling asleep or staying asleep, waking up early and feeling tired, poor sleep, sleeplessness)
- Increased need for sleep, often feeling tired
- Irritability (feeling aggressive, easily upset about little things, moody)
- Nervousness (inner tension, restlessness, feeling fidgety)
- Anxiety (feeling panicky)
- Physical exhaustion/lacking vitality (general decrease in performance, reduced activity, lacking interest in leisure activities, feeling of getting less done or of achieving less or of having to force oneself to undertake activities)
- Decrease in muscular strength
- Depressive mood (feeling down or sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use)
- Feeling that you have passed your peak
- Feeling burnt out, having hit rock bottom
- Decrease in beard growth
- Decrease in ability/frequency to perform sexually
- Decrease in morning erections
- Decrease in sexual desire/libido (lacking pleasure in sex or desire for sexual intercourse)
How To Determine Results:
After answering the above questions, look at how many you answered with mild or more severe symptoms. This will give you an idea of the severity of your hormonal imbalance.
If this questionnaire has shown you that there may be an issue with your hormones, then the next step is to get your hormone levels evaluated by your New Leaf Wellness provider who specializes in hormone balancing.
Contact us to get started!
Call 888-728-7555 or e-mail us.