Your Full Name:

Email:

I have been diagnosed with a metabolic disorder.

YesNo

My metabolism is sluggish, and I gain weight easily.

YesNo

I have been diagnosed with hypothyroidism.

YesNo

I feel cold a lot of the time.

YesNo

I am often tired or lethargic, and I don’t have much endurance or motivation.

YesNo

I need a lot of sleep.

YesNo

I am something short of breath.

YesNo

I perspire easily with exertion.

YesNo

I am overweight.

YesNo

I often crave carbohydrates.

YesNo

I bruise easily.

YesNo

My libido is low.

YesNo

I sometimes feel dull and have trouble concentrating.

YesNo

I catch cold easily.

YesNo

It takes a long time to recover from an illness.

YesNo

My complexion is pale or sallow.

YesNo

My energy is low after I eat, and I get bloated.

YesNo

I sometimes have dark circles under my eyes.

YesNo

I often experience digestive complaints such as loose stools, abdominal pain, and flatulence.

YesNo

My first bowel movement of the day is often loose.

YesNo

My appetite is generally poor or erratic.

YesNo

I don’t have much muscle tone; I feel weak.

YesNo

I am prone to low back or knee pain.

YesNo

I have poor circulation.

YesNo

I prefer hot weather/ I hate the cold.

YesNo

I have cold limbs or cold hands and feet.

YesNo

Given the choice, I would prefer a hot drink.

YesNo

I urinate frequently, and the urine is very pale or clear.

YesNo

I retain water.

YesNo

I have been diagnosed with low progesterone levels or LPD.

YesNo

I experience spotting before my period starts

YesNo

My period is heavy but short, it seems to come all at once.

YesNo

My menstrual cycle is long.

YesNo

I frequently have profuse vaginal discharge, that has no odor, especially mid-cycle.

YesNo

I have a long period; it lasts longer than 7 days.

YesNo

I suffer from loose stools during my period or premenstrual.

YesNo

I get menstrual cramps that are relieved with heat (such as a heating pad).

YesNo

My BBT is generally low, sometimes so low that it’s literally off the chart.

YesN/A

I have a short luteal phase, less that 12 days; my period starts 11 days or less after my last day of egg-white mucus.Possible LPD ( Luteal Phase Defect) due to insufficient progesterone.

YesN/A

My luteal phase temperatures are low.

YesN/A

My BBT is below 97.2 °F in my follicular phase.

YesN/A

My follicular phase lasts 16 days or more (late ovulation).

YesN/A

I have no temperature change between my follicular and luteal phases.No ovulation.

YesN/A

My BBT shifts slowly at ovulation, rising 0.2 °F or 0.3 °F a day.

YesN/A

My BBT dips around ovulation, then slowly climbs 0.2 °F or 0.3 °F a day over 3 to 4 days to my post-ovulation BBT.Body slow to react to increasing progesterone.

YesN/A

My BBT drops too soon after ovulation (low progesterone).

After ovulation, BBT should rise within 1 to 2 days and remain high until just before your start next period starts. If pregnancy occurs, it should stay high right through the early weeks.

YesN/A

My BBT rises slowly through the luteal phase.Slow reaction to increasing progesterone.

YesN/A

My BBT rises in the luteal phase but doesn’t stay up for 12 days.Premature drops in progesterone.

YesN/A

My BBT forms a saddle-shaped pattern in the luteal phase – rising, falling, then rising again.Due to a small surge in estrogen about a week after ovulation; this may be accompanied by an increase in cervical mucus, signaling failure to sustain progesterone.

YesN/A

My BBT drops erratically during the luteal phase.Possible LPD.

YesN/A

I have experienced night sweats.

YesNo

My skin, hair, and/or nails are dry.

YesNo

I have dry eyes.

YesNo

I often feel hot.

YesNo

I sometimes feel feverish in the afternoon.

YesNo

I wake up during the night.

YesNo

I am often thirsty.

YesNo

My mouth and throat often feel dry.

YesNo

I tend to be constipated.

YesNo

My bowel movements are hard and dry.

YesNo

I prefer colder weather.

YesNo

Given the choice, I would prefer a cold drink.

YesNo

My hands and feet tend to be hot or sweaty.

YesNo

My chest sweats, especially at night.

YesNo

I flush easily or have a red face.

YesNo

I often feel anxious or uneasy; I am a worrywart.

YesNo

I am thin.

YesNo

I am restless and fidgety.

YesNo

I am tired a lot.

YesNo

I am a restless sleeper.

YesNo

I have vivid dreams.

YesNo

My vagina often feels dry and unlubricated.

YesNo

I have been diagnosed with low estrogen levels.

YesNo

I have experienced hot flashes.

YesNo

My cycle is long, and my period is short and light.

YesNo

My BBT is on the high side throughout my cycle.

YesN/A

My chart changes a bit from month to month.

YesN/A

I have an unsteady BBT or temperature spikes in the follicular phase.

YesN/A

My follicular phase lasts longer than 13 to 14 days.Low estrogen, low FSH, or reduced sensitivity to FSH.

YesN/A

My follicular phase is shorter than 12 days (ovulation).

YesN/A

I ovulate late.

YesN/A

I have spotting at ovulation.

YesN/A

I see no clear temperature change between the follicular and luteal phases (no ovulation).

YesN/A

My luteal phase is short (less than 12 days); my period starts 11 days or less after my last day off egg-white mucus (possible LPD).

YesN/A

My luteal phase is long (more than 14 days).

YesN/A

My luteal phase temperatures are high (above 98.4 °F).

YesN/A

My luteal phase temperatures are erratic.

YesN/A

I am often irritable.

YesNo

I feel tense, overwhelmed or just generally stuck.

YesNo

My bowel movements are thin and long like a ribbon.

YesNo

My bowel movements are like small pebbles.

YesNo

My ribs or flanks are painful or distended.

YesNo

I feel better or have more energy with exercise.

YesNo

I am stressed-out.

YesNo

I sigh a lot.

YesNo

I grind my teeth at night.

YesNo

I have tense muscles.

YesNo

I have poor circulation.

YesNo

I feel as if I can’t quite clear my throat.

YesNo

I have cold hands and feet.

YesNo

I have discomfort, cramps, or pain with my period.

YesNo

My breasts are sore premenstrual and sometimes at ovulation.

YesNo

I have mood swings and/or irritability, especially right before my period.

YesNo

I have PMS.

YesNo

I have been diagnosed with fibroids or uterine polyps.

YesNo

I have been diagnosed with endometriosis.

YesNo

I have been diagnosed with elevated prolactin levels.

YesNo

I have an irregular menstrual period.

YesNo

My period stops and starts.

YesNo

My period is very light.

YesNo

I have a very heavy menstrual flow.

YesNo

My menstrual blood is clotted and/or dark red or brown rather than bright red.

YesNo

My BBT takes a few days to rise after the LH surge at ovulation .

The body is slow to react to increasing progesterone. After ovulation, BBT should rise within 1 to 2 days and remain high until just before your next period starts. If pregnancy occurs, it should stay high right through the early weeks.

YesN/A

My BBT chart has a sawtooth pattern during the luteal phase, fluctuating daily by 0.3 °F or more (probably caused by stress)

YesN/A

My BBT does not drop right away when I begin a new cycle.

YesN/A

My BT is unstable and unpredictable; it varies from month to month.

YesN/A

My face is pale, especially my lips.

YesNo

My nail beds are pale, and my nails are dry and break easily.

YesNo

I get dizzy easily, especially if I stand up quickly.

YesNo

I have blurry vision or floaters.

YesNo

I have trouble falling asleep.

YesNo

I am tired.

YesNo

My hair is thin and/or dry; I have been experiencing hair loss.

YesNo

I am a vegan or vegetarian.

YesNo

Sometimes I get palpitations.

YesNo

I often feel shaky.

YesNo

My muscles are tight, and it doesn’t take much for me to injure them.

YesNo

I have a light menstrual flow.

YesNo

I have a short period (shorter than 3 days).

YesNo

I sometimes miss a period, or my period is late.

YesNo

My menstrual blood is pink rather than bright red.

YesNo

I get weepy and needy premenstrually.

YesNo

I have a dull pain after my period is over.

YesNo

My BBT chart shows a long follicular phase (late ovulation)

YesN/A

My BBT chart shows a long luteal phase.

YesN/A

I have trouble controlling my weight.

YesNo

My thinking often feels clouded.

YesNo

I have sinus problems, seasonal allergies, or chronic cough.

YesNo

I have a tendency toward edema, or swelling.

YesNo

My hands or feet swell.

YesNo

I often feel tired and sluggish.

YesNo

I get achy joints.

YesNo

My arms and legs feel heavy.

YesNo

My mouth feels greasy.

YesNo

I feel bloated.

YesNo

I often suffer from yeast infections or have been diagnosed with Pelvic Inflammatory Disease (PID)

YesNo

I have PCOS.

YesNo

I have been diagnosed with fibroids or uterine polyps.

YesNo

I have been diagnosed with endometriosis.

YesNo

I have painful periods, with mucus and clots.

YesNo

I experience clear, copious cervical mucus throughout my cycle or at erratic points in my cycle.

YesNo

My BBT varies from month to month.

YesN/A

My BBT forms a jagged sawtooth pattern, changing almost daily by 0.3 °F or more.

YesN/A

My BBT chart shows a long follicular phase.

YesN/A

I’m not ovulating (anovulation).

YesN/A

I’m ovulating unpredictably, on a different day during each cycle.

YesN/A

My BBT doesn’t change much or at all after ovulation. I have a monophasic, as opposed to biphasic, BBT chart.

YesN/A

My BBT chart shows a luteal phase longer than 16 days (I’m not pregnant) and a spike in temperature when my period should be starting (potential ovarian cyst).

YesN/A

My BBT rises slowly after ovulation; it takes a few days to come all the way up.

YesN/A

Time is Up!

test

COVID-19 PROTOCOL

Book an Appointment

NEW PATIENT OFFER