Female Hormone Deficiency Questionnaire Fill out online or download & print to fill out offline. Download & Print Name First Last Number*AgeWeightHeightPlease answer each of the questions below by choosing 'yes' or 'no'.Do you have difficulty waking up in the mornings?YesNoDo you always feel tired or exhausted?YesNoDo you sleep poorly?YesNoAre you frequently anxious, nervous or irritable?YesNoDo you suffer from short- or long-term memory loss?YesNoDo you have trouble concentrating?YesNoDo you lack sexual desire?YesNoHave you lost your attraction toward your partner?YesNoAre you currently experiencing vaginal dryness?YesNoHave you recently gained weight or do you have difficulty losing weight?YesNoDo you carry your weight in your mid-section?YesNoHave you lost muscle mass, tone and/or strength?YesNo