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

Field is required!
Field is required!
Field is required!
Field is required!

Gender

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

Symptoms

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

Family History

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