Help Me Help You!

Help Me Help You
General Information:


Select all that apply from the following.
Do you take medications for any of the following?


 Clomid
 Letrozole
 Injectables (fertility)
 Glucophage
 Metformin
 Synthroid
 Anti-histamine
 Anti-depressants
 Insulin
 No


Do you suffer from any of the following?

 Anxiety
 Asthma
 High Blood Pressure
 High cholesterol
 Heartburn


Are any of these statements true?

 I have a Luteal Phase Defect (LPD)
 I have had a Tubal Reversal
 I have Endometriosis
 I have PCOS (PolyCystic Ovarian Syndrome)
 I have Blocked Tubes
 I have had an ectoptic pregnancy
 I have had a miscarriage(s)
 I have fibroids
 I have a low sex drive
 I get migraines
 I am dealing with a male factor (low sperm count)
 Other


   

Are you Underweight, Normal, Overweight or Obese?

Height:
Weight:
BMI:


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*PLEASE NOTE: The information provided on this site is intended to serve only as a supplement to your resources and is in no way to be considered medical advice, medical diagnosis or treatment. Always check with your obstetrician, physician, midwife, or other health care provider before choosing to do or not do any course of action.

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