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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
3
33%
Let's Get Started
Which of the following symptoms of menopause are you experiencing?
(Required)
Hot flashes
Difficulty sleeping
Brain fog
Daytime fatigue
Sexual dysfunction
Other
None
Are you experiencing difficulty with any of the following?
(Required)
Memory
Word retrieval
Slow thinking
Processing new information?
Other
None
CleopatraRX and the PearlPAK treatment may not be right for everyone. In order to determine if PearlPAK is right for you, please respond to the following:
I confirm that I am a biological female.
(Required)
Yes
No
I confirm that I am neither pregnant nor trying to become pregnant.
(Required)
Yes
No
I confirm that I do not have a history of breast, uterine, or ovarian cancer. (Abnormal pap smears are unrelated to cancers noted in this question and do 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
I confirm that I do NOT have a history of liver disease, endrocrine disease or other serious illness.
(Required)
Yes
No
When was your last gynecological visit?
(Required)
0-12 months
13-24 months
24 months 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 tissue and fibrocystic disease are not related and do 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
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Thank you for completing the questionnaire. The next step will direct you to one of our licensed patient care professionals to assist you in determining if the PearlPAK treatment is a good fit for you. At this stage, your credit card number is collected but NO FEES ARE CHARGED until AFTER to appointment with the physician. The physician visit fee is $49 and will be process ONLY AFTER your visit. If you have added a promo code there will be no physician fee after you visit. If you and the physician decide to move forward with a prescription, a separate transaction will be processed for the prescription for $97. Please also reference your email for additional information.
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