Get Hormore Replacement Therapy Questionnaire

Filling out the Hormone Replacement Therapy Questionnaire online can be a straightforward process when you follow a clear guide. This document helps healthcare providers assess your medical history and current health needs in relation to hormone replacement therapy.

Follow the steps to successfully complete the questionnaire.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter your personal data in the designated fields. This includes your name, date of birth, gender, age, and the name and office number of your primary physician.
3. Provide your personal medical history by indicating any relevant conditions or diseases you have had, using the checklist provided. Mark 'Yes' or 'No' as applicable.
4. If applicable, provide details about your smoking and alcohol consumption, including frequency.
5. For individuals assigned female at birth, answer specific questions regarding menstruation, pregnancy, and contraception, like the date of your last menstrual period and any other relevant information.
6. List any medications, vitamins, and supplements you currently take or have taken in the past. Ensure to note any known allergies.
7. Fill out the family medical history section, providing details about any family member who has experienced significant medical conditions.
8. Indicate your hormone therapy history and specify which types of hormones you have used in the past or are currently using.
9. Describe any present symptoms you may be experiencing, focusing on changes related to aging, mood, and overall health.
10. Review the list of symptoms related to hormone health and check boxes next to any that are troublesome or persistent for you.
11. In your own words, describe what you hope to achieve from this program in the space provided.
12. Complete the signature fields for both the patient and the provider. Ensure all information is accurate before submission.
13. Save changes, download, print, or share the completed form as necessary.

Begin filling out your Hormone Replacement Therapy Questionnaire online today to ensure your health needs are addressed.