Menopause symptom questionnaire

Use this questionnaire to record any symptoms you may be experiencing for further discussion with your health professional.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on 01603 415519.