What is your question?

How old is your patient?

Is she naturally pre, peri or post menopausal?

Please give a brief history of your patient.

When in her cycle do her symptoms occur? Please elaborate!

How long has she been symptomatic?

Does she have a uterus?

How many children does she have?

What was her modality of birth?

Did she breast feed?

What is her BMI? (thin, average or obese)

What is her history of antibiotic use?

What is her history of PPI’s, gut surgery, detoxification programs, etc?

What is your frequency & quantity of bowel movements?

How long has she been on the protocol?

What are her current doses?

What have you tried to rectify this situation?

Does she bleed monthly?

What other hormones does she takes?

What medications, if any, does she take?

Is she a big supplement user?

Pertinent labs and scans?

Which pharmacy are you using for this prescription?

Has your patient taken the Covid shot?

How many?

Have they had Covid?

How many times?

Prior to or after the shot?

What is your name and contact info?

Is your request urgent?

All non urgent requests will be responded to within 48 hours.

Please sign our attached indemnification form and email to info@womenshormonenetwork.org Thank you

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