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Get in touch

(504) 267-4549

info@chronosbhw.com

Home
Aesthetics
Wellness
Fitness Center
- 24-Hour Fitness Center
- Pilates Studio Sessions
Specials
Patient Support
Contact Us

FEMALE HRT QUIZ

Find out if you are a candidate for Female Hormone Replacement Therapy at Chronos:

Female HRT Quiz

First Name:

Last Name

Email:

Mobile Phone:

Address

Are you experiencing fatigue?

Never

Mild

Moderate

Severe

Memory Loss/ Confusion?

Never

Mild

Moderate

Severe

Hot Flashes/ Night Sweats?

Never

Mild

Moderate

Severe

Difficulty sleeping or staying sleep?

Never

Mild

Moderate

Severe

Mood Changes / Nervousness?

Never

Mild

Moderate

Severe

Vaginal Dryness?

Never

Mild

Moderate

Severe

Weight Gain / Belly Fat / Inability To Lose Weight?

Never

Mild

Moderate

Severe

Decreased Desire / Libido?

Never

Mild

Moderate

Severe

Cold all the time?

Never

Mild

Moderate

Severe

Depressed Mood?

Never

Mild

Moderate

Severe

Joint Pain?

Never

Mild

Moderate

Severe

Are you 40 or older?

Yes

No

Osteoporosis Family History

Yes

No

Alzheimer's Disease Family History

Yes

No

Heart Disease Family History

Yes

No

Diabetes Family History

Yes

No

Thank you for choosing Chronos to support your wellness. Dr. Scott will review your quiz results, and a team member will contact you with next steps shortly.

Oops, there was an error sending your message.
Please try again later.

LegitScript approved

Home
Aesthetics
Wellness
Fitness Center
Specials
Contact Us

Chronos Body Health & Wellness

info@chronosbhw.com

3200 N. Arnoult Rd. Metairie, LA 70002

Smooth Aesthetics

4750 Bluebonnet Blvd, Suite A
Baton Rouge, LA 70809

Download the "Chronos BHW" App for easier appointment booking and profile management!

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