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  • Menopause & Hormonal Balance Herbal Consultation – Health ConnectShen

    Please allow approximately 15–30 minutes to complete this consultation form. The information provided helps us prescribe safe and effective herbal medicine and provide personalised healthcare recommendations. Please provide your personal details, health history, and current concerns to help us tailor your herbal treatment plan. Senior Practitioner: Dr Nicky Macdonald (Chinese Medicine) and Dr Natalie Westwood (Chinese Medicine). Website: www.healthconnectshen.com.au. Phone: 0409 230 261.

  • Patient Details

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Menstrual & Hormonal History

  • Stage of Menopause*
  • Date of last menstrual period (if applicable)
     - -
  • Cycle regularity (before menopause)

  • Hot Flushes

  •

  • Night Sweats

  • Sleep Quality

  •
  • Do you have difficulty falling or staying asleep?

  • Mood & Anxiety

  • Do you experience changes in mood or anxiety?

  • Libido

  • Have you noticed changes in libido?

  • Vaginal Dryness

  • Do you experience vaginal dryness?

  • Fatigue

  •

  • Weight Changes

  • Have you experienced weight changes in the past year?

  • Digestive Symptoms

  • Do you experience any of the following digestive symptoms?

  • Musculoskeletal Pain

  • Do you experience musculoskeletal pain?

  • Bone Health

  • Have you been diagnosed with osteoporosis or osteopenia?

  • HRT Use

  • Are you currently using hormone replacement therapy (HRT)?

  • Medications & Supplements

  • Cardiovascular History

  • Do you have a history of any of the following?

  • Emotional Wellbeing

  • Lifestyle Factors

  • Do you smoke or use tobacco products?

  • TCM Constitutional Assessment

  • Which of the following best describes your constitution? (Select all that apply)
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If you have any questions with your purchase, please email: connect@healthconnectshen.com.au