Female Hormone Wellness Quiz

Complete our Female Hormone Wellness Quiz to get a better understanding of whether you are a good candidate for hormone pellet therapy. If you would like for Duke City Health to reach out to you about your treatment options, please provide us with your contact information in the fields at the end of this form.

We take your privacy seriously. The information submitted through this form will only be shared with the staff at Duke City Health.

FEMALE HORMONE PELLET THERAPY FAQ

Your Contact Info

Your First Name
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Field is required!
Your Last Name
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Email Address
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Best number to reach you at
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Field is required!

Gender

  • - Please Select -
  • MALE
  • FEMALE
- Please Select -
You must provide your gender
You must provide your gender

Symptoms

Please select a gender to show symptoms
FATIGUE
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Field is required!
MOOD CHANGES
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DECREASED MENTAL ABILITY
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Field is required!
EXCESSIVE SWEATING
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Field is required!
HOT FLASHES / NIGHT SWEATS
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Field is required!
WEIGHT GAIN
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Field is required!
DECREASED SEX DRIVE
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Field is required!
SLEEP PROBLEMS
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COLD HANDS & FEET
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Field is required!
DECREASED MUSCLE STRENGTH
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Field is required!
HAIR LOSS
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Field is required!
HAIR LOSS & BREAKAGE
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Field is required!
DRY, ITCHY SKIN
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Field is required!
JOINT PAIN
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Field is required!

Family History

Please select a gender to show family history questions
Check All That Apply
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Field is required!
Check All That Apply
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Field is required!
Kristi Fury CFNP Family Medicine Nurse Practitioner Specializing in Hormone Therapy and Regenerative Medicine in Albuquerque, New Mexico 87120