Age & Menopause Stage Under 40 40-45 and experiencing menopausal symptoms 46-55 and experiencing menopausal symptoms Over 55 and considering HRT for ongoing symptoms or bone/heart health None Menopausal Symptoms (choose all that apply) Hot flushes/night sweats Sleep disturbances Brain fog or difficulty concentrating Mood swings, anxiety, or low mood Joint or muscle aches Loss of libido Vaginal dryness or discomfort None Your preference for a “Natural” Approach I want hormones that match those my body makes I am open to different forms, but prefer the safest option I don’t mind synthetic hormones None Delivery Method Preference I prefer skin patches, gels or sprays rather than tablets I prefer tablets No preference None Health Factors (Tick any that apply to you now or in the past) History of breast cancer History of blood clots Uncontrolled high blood pressure Severe liver disease Unexplained vaginal bleeding None Sleep & Mood I struggle with poor sleep or low mood and want non-sedative, mood-friendly support My mood and sleep are find None Bone & Heart Health Concerns I have a family history of osteoporosis or heart disease I have no concerns in this area None Name Age DOB Mobile No Email City Time's up
