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Women's Health & Vitality Assessment

Women's Health Assessment
 
Which of the following symptoms apply to you currently (in the last 2 weeks)? Please make the appropriate selection for each symptom down below. For symptoms that do not currently apply or no longer apply, mark "none".
 
Symptoms
 
 
 
NOTE: Please add up your score and enter it below.
Severity Score: Mild 1-20 / Moderate: 21-40 / Severe: 41-60 / Very Severe: 61-80
 

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