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PLIMPTON

Obstetrics & Gynecology

Hormone Replacement for Women & Men

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Depressive mood *

Never

Mild

Moderate

Severe

Anxiety *

Never

Mild

Moderate

Severe

Memory loss/Brain fog *

Never

Mild

Moderate

Severe

Decreased sex drive/Libido *

Never

Mild

Moderate

Severe

Difficult to climax sexually *

Never

Mild

Moderate

Severe

Sleep problems *

Never

Mild

Moderate

Severe

Mood changes/Irritability *

Never

Mild

Moderate

Severe

Fatigue *

Never

Mild

Moderate

Severe

Migraine/Severe headaches *

Never

Mild

Moderate

Severe

Weight gain *

Never

Mild

Moderate

Severe

Vaginal dryness *

Never

Mild

Moderate

Severe

Hot flashes *

Never

Mild

Moderate

Severe

Night sweats *

Never

Mild

Moderate

Severe

Dry and wrinkled skin *

Never

Mild

Moderate

Severe

Hair is falling out *

Never

Mild

Moderate

Severe

Cold all the time *

Never

Mild

Moderate

Severe

Joint pain *

Never

Mild

Moderate

Severe

THANK YOU FOR SUBMITTING!

OUR STAFF WILL BE CONTACTING YOU SOON WITH YOUR RESULTS

Female Symptom Assessment

Opening Hours

Monday through Thursday

8:00 am to 5:00 pm

Friday

8:00 am to 12:30 pm

Closed Holidays

Contact us for more information

Your details were sent successfully!

doctor@drplimpton.com

© 2017 C. Steven Plimpton M.D., P.C.

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