Get in touch Title Of Address 34 Harley Street London LD23 5hg 0204 445 7761 [email protected] Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *Email *Telephone NumberAgeHave you noticed any changes in your menstrual cycle recently?Irregular periods (e.g., shorter or longer cycles, heavier or lighter flow)Changes in the duration of your periodsMissed periods or skipped cyclesOther changesAre you experiencing any of the following symptoms? Please indicate the severity for each symptom on a scale of 1 to 5 1 being mild and 5 being severe Hot flashes or night sweats Selected Value: 1 Mood swings or irritability Selected Value: 1 Fatigue or low energy levels Selected Value: 1 Sleep disturbances (e.g., insomnia, restless sleep) Selected Value: 1 Vaginal dryness or discomfort during intercourse Selected Value: 1 Changes in libido (sex drive) Selected Value: 1 Memory lapses or difficulty concentrating Selected Value: 1 Weight gain or changes in body composition Selected Value: 1 Headaches or migraines Selected Value: 1 Joint or muscle pain Selected Value: 1 Other symptoms (please specify) Have you noticed any changes in your mood or emotional well-being? 1 being mild and 5 being severe Increased anxiety or feelings of unease Selected Value: 1 Depression or feelings of sadness Selected Value: 1 Irritability or anger Selected Value: 1 Mood swings Selected Value: 1 Other symptoms (please specify)Are you experiencing any physical changes in your body?Changes in skin elasticity or drynessHair thinning or hair lossChanges in breast tissueOther changesOther symptoms (please specify) Have you had any difficulties with memory or concentration recently?YesNoNot SureAre you currently experiencing any sexual symptoms?Decreased libido (sex drive)Vaginal dryness or discomfort during intercoursePainful intercourseOther changesOther symptoms (please specify)Have you had any significant lifestyle changes recently? (e.g., changes in diet, exercise, stress levels)YesNoAre you currently taking any medications or supplements? If yes, please list them:Have you discussed your symptoms with a healthcare professional?Yes, and I have received treatment or adviceYes, but I have not received treatment or advice yetNo, I have not discussed my symptoms yetGDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.Submit
