1288 Ritson Rd N Unit 12, Oshawa, ON L1G 7Z9

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PATIENT REGISTRATION

Empower Yourself: Begin Your Assessment

Take The Female Health Assessment

Female Health Assessment

First Name

Last Name

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Symptoms

Please mark the appropriate box for each symptom you may be experiencing.

Physical Exhaustion (fatigue, lack of energy, stamina or motivation)

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None
Mild
Severe
Very Severe
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Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)

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None
Mild
Moderate
Severe
Very Severe
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Decline in drive or interest (loss of “zest for life,” feeling down or sad)

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None
Mild
Moderate
Severe
Very Severe
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Vaginal dryness or difficulty with sexual intercourse

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
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Difficulties with memory (concentration, finding the right word, or retaining information)

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None
Mild
Moderate
Severe
Very Severe
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Sweating (night sweats or increased episodes of sweating)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Irritability (mood swings, feeling aggressive, angers easily)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sleep Problems (difficulty falling asleep or sleeping through the night)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
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Feeling cold all the time, having cold hands or feet

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
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Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Weight (difficulty losing weight despite diet/exercise)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Bladder problems (difficulty in urinating, increased need to urinate, incontinence)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Sexual Problems (change in desire, activity, orgasm and/or satisfaction)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Hair loss, thinning or change in texture of hair

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Hot Flashes (burst that starts in chest and lasts for short duration)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Headaches or migraines (increase in frequency or intensity)

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None
Mild
Moderate
Severe
Very Severe
No elements found. Consider changing the search query.
List is empty.

Do you have hot/cold fluctuations?

Yes
No
No elements found. Consider changing the search query.
List is empty.

Other symptoms or unique health circumstances to take into consideration:

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Clinic For Advanced Health

At the Clinic For Advanced Health, believe in offering a holistic model that integrates both conventional medicine and alternative therapies to form a comprehensive individualized treatment plan that is uniquely customized to each person’s needs.

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About

Address: 1288 Ritson Rd N Unit 12, Oshawa, ON L1G 7Z9

Phone: +1 289-274-6120
Fax: (905) 240-2155

Hours of Operation: 9am - 5pm Mon - Thurs

Services

Hormone Pellet Therapy

Estrogen Restoration Therapy

Progesterone Therapy

Testosterone Therapy

Thyroid Hormone Replacement

Low Dose Naltrexone

Cannabinoid (CBD) Therapy

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