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HRT pre-counselling questionnaire

HRT Pre-Counselling Questionnaire

Section

Please select any symptoms that you are currently experiencing:
For example, 31/3/2025
Are you still having periods?
Are you currently using contraception?
e.g., contraceptive pill, hormonal coil, condoms
Have you had a hysterectomy?
Are you experiencing any abnormal vaginal bleeding?

Medical History

Have you had any of the following conditions?
Have any of your close relatives been diagnosed with any of the following?
Do you smoke?
in kg
in metres

Blood Pressure

Please provide a recent blood pressure reading.