Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Hormonal Health & Symptom Tracking Study
We're researching how women experience the recurring "off-weeks" some people get around their period. There are no right answers and we're not selling anything. Two minutes, anonymous.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
How do you describe yourself?
*
Woman
Man
Non-binary
Prefer not to say
How old are you?
*
Under 18
18–21
22–29
30–34
35–44
45+
Do you notice a 'bad week' or 'off-week' that tends to show up around the same time each month?
*
Yes, almost every month
Yes, often but not every month
Sometimes, but I can't predict it
Not sure
No, not really
When that off-week shows up, what do you usually notice first?
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of HerLyfe.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report