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Which symptoms of menopause are you experiencing?

Are you experiencing difficulty with any of the following?

I confirm that I am a biological female.

I confirm that I am NOT currently pregnant nor am I trying to get pregnant.

I confirm that I do not have a history of breast, uterine, or ovarian cancer. (Abnormal pap smears are unrelated to cancers noted in this question and do not apply)

I confirm that I do NOT have a history of heart attack, stroke and/or blood clots.

I confirm that I do NOT have a history of liver disease, endrocrine disease or other serious illness.

When was your last gynecologist visit?

I confirm that I have had a mammogram in the last 2 years AND there was no evidence of breast cancer. (dense breast and fibercystic disease is not related and does not apply)

Almost finished. Thank you for going through the questionnaire to make sure the physician has the information needed to prescribe the best solution for you.  One last question.   

In order to make sure the PearlPAK treatment is tailored to your specific needs, it's important to know whether or not you have a uterus.  Please check one of the options below.

I confirm that I have my uterus and have NOT had a hysterectomy

Full Name
Email
Phone

Date of Birth

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State*

Have you ever had an allergic reaction to estrogen or progesterone treatment?