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HRT Quiz for
Women
Name
Email
Phone
Do you experience irregular periods?
Yes
No
Do you have trouble sleeping?
Yes
No
Do you experience digestive issues?
Yes
No
Do you experience extreme fatigue?
Yes
No
Do you have mood swings and/or depression?
Yes
No
Do you have regular headaches?
Yes
No
Unexplained Weight Gain?
Yes
No
Lessened sex drive?
Yes
No
Changes in your Breasts?
Yes
No
Night Sweats?
Yes
No
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