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Online Visit
valethealth
2024-03-21T23:06:26+00:00
Start your online journey to see if PearlPAK™ is right for you
Online Visit
Step
1
of
4
25%
Let's Get Started
Are you experiencing any of the following symptoms?
(Required)
Hot flashes
Problems sleeping
Brain fog
Fatigued during the day
Sexual issues
Other
None
Are you having cognitive symptoms of menopause?
(Required)
Difficulty with memory
Difficulty Word Finding
Difficulty with Slow Thinking
Difficulty with processing new information?
Other
None
CleopatraRX and the PearlPAK treatment may not be right for everyone. We want to make sure that you are safe and that this medication is right for you. In order to best understand the fit, please respond to the following.
I confirm that I am biologically female.
(Required)
Yes
No
I confirm that I am NOT currently pregnant nor am I trying to get pregnant.
(Required)
Yes
No
I confirm that I am NOT being actively treated for or do NOT have a history of breast cancer, uterine cancer or ovarian cancer. (an abnormal pap smear is unrelated to cancers noted in this question and does not apply)
(Required)
Yes
No
I confirm that I do NOT have a history of heart attack, stroke and/or blood clots.
(Required)
Yes
No
When was your last gynecologist visit?
(Required)
0-12 months
13-24 months
24 month or more
I confirm that I have had a mammogram in the last 2 years AND there was no evidence of breast cancer. (dense breast and fibercystic disease is not related and does not apply)
(Required)
Yes
No
Almost finished. Thank you for going through the questionnaire to make sure the physician has the information needed to prescribe the best solution for you. One last question. In order to make sure the PearlPAK treatment is tailored to your specific needs, it's important to know whether or not you have a uterus. Please check one of the options below.
I confirm that I have my uterus and have NOT had a hysterectomy
(Required)
Yes
No
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