Women's Wellness
SHC's comprehensive wellness initiative seeks to provide patients with a variety of choices during every stage of their menstrual cycles. Personalized feedback from this survey ensures that you are well informed and able to make the best decisions for what your body needs to stay healthy.
Tell us about yourself! What is your name?
Your answer
What email can we send your personalized wellness report and feedback to?
Your answer
Age
Your answer
Height
Your answer
Weight
Your answer
Overall, how would you rate your health?
Do you suffer from any of the following?
Do you have any family history for any of the illnesses listed above? Please explain
Your answer
What aspect of your health are you looking to learn more about? (Check all that apply) *
Required
Do you have children or are planning to have children?
Do you experience any of the following in your ears, nose or throat? Check all that apply
Do you experience any of the following cardiovascular system issues? Check all that apply.
Do you experience any of the following respiratory system issues? Check all that apply.
Do you experience any of the following gastrointestinal problems? Check all that apply.
Do you have any of the following skin and health concerns? Check all that apply.
Do you experience any of the following emotional conditions? Check all that apply.
Do you experience any of the following not previously listed? Check all that apply.
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