Menopause: Symptom Score Sheet

*** This form will be submitted electronically by standard email as a password-protected pdf file directly to the practice nurse. If you wish to send your name and date of birth in a de-identified manner please write a bogus name and advise reception by phone to link to your file. ***

  • Instruction

    When you submit the questionnaire, you will see your score at the next screening with an explanation.

    SEVERITY OF PROBLEM IS SCORED AS FOLLOWS
    None =0
    Mild =1
    Moderate =2
    Severe =3+

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