Female

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Women's Wellness

* Indicates required field

Name *

First

Last

Email *

Please complete all sections that apply:

I am currently: *

Trying to get pregnant Pregnant Nursing

Pre-Menstrual Issues

If you are having a menstrual cycle, please check any PMS issues you experience. These are generally persistent symptoms 3-14 days before menses: *

Anxious, irritable or restless Numbness or tingling in hands or feet Easily angered or resentful Agressive or hostile toward family and friends Abdominal bloating or swelling anywhere Temporary weight gain Breast tenderness, swelling Breast lumps Discharge from nipples Nausea or vomiting Diarrhea or constipation Aches and pains Crave sweets Increased appetite, binging Headache Overwhelmed, shaky or clumsy Pounding heart Dizzy or fainting Confused and forgetful Overwhelmed by sadness and self-worth issues Sleep issues Self-destructive

Menstrual Issues

Choose any that apply: *

Cramps in lower abdomen or pelvis Lower abdominal pain (sharp, dull or intermittent) Bloating and abdominal fullness Diarrhea or constipation Nausea or vomiting Low back or leg ache Headache Fatigue, naps interfering with life Pain or swelling in breasts Scanty flow

Pelvic Inflammation

Please check any that apply to you: *

Painful or difficult intercourse Ongoing lower abdominal, back and vaginal pain Pelvic pressure or pain better lying down Vaginal bleeding not during period Painful bowel movements Strain with urination Abnormal vaginal discharge Offensive vaginal discharge Vaginal itching or burning (independent of intercourse) Increasing pain during periods Heavy or long bleeding Unable to get pregnant

Female Balance

Mark any that apply: *

No periods for at least 6 months Irregular cycle Heavy bleeding Clots and tissue in blood Bleeding between periods Cycle longer than 35 days Intense upper stomach pain at ovulation (Day 14) Bleeding at ovulation (Day 14) Abdominal pain monthly without bleeding Abundant cervical mucus Acne or oily skin Overwhelming urge for intercourse Agressive feelings Increased growth of dark facial or body hair Loss of smell Voice deepening Breasts shrinking Receding hairline

Ovarian Issues

Please check all that apply to you: *

Vaginal discharge Thin, watery vaginal secretions Dry vagina Discomfort with intercourse Reduced libido Engorged breasts Breasts tender Difficulty with orgasm Vaginal bleeding after intercourse Skip periods Length of cycle varies with decreasing number of days of flow

Menopausal Issues

Check all that apply: *

Wellbeing fluctuates without cause Sudden hot flashes Spontaneous sweating Chills Cold hands and feet Heart beats fast or flutters Numbness or tingling Dizziness Mind fog, distractibility or memory issues Poor concentration Depression, anxiety, nervousness or irritability Sleep issues New feelings of anger or frustration Dry skin, hair, vagina and/or eyes Menstruation stopped (e.g. 6 months ago) but still have some bleeding

Now that you have checked all your female wellness issues, please describe your stongest female-related symptom: *

Rate your worst symptom: *

1 Minimal 2 Mild 3 Moderate 4 Strong 5 Maximum

Be sure you also complete the questionnaire about your general wellness issues, and the survey of psychoemotional stress patterns, and then apply for consulting, an energy scan, biofield analysis, health coaching and your individually formulated natural remedy program.

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Home
Pricing
Consult
- Application
- Animal
Store
- Shop >
  - Supplements >
    
    Homeopathics
  - NES >
    
    Infoceuticals >
    
    FeelGood Infoceuticals
  - Zyto
  - Water
  - Kitchen
  - Skin Care
  - Eye Care
  - Dental
  - Local Services
  - Remote Services
  - Print Books
  - Ebooks
  - DVDs
  - Music CDs
Links
Contact
Search
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