Your copy of PHP Form Builder is NOT authorized.
About PHP Form Builder License

BWC Menopause
Symptom Score Sheet


This valuable diagnostic tool can be completed prior to an initial appointment to gauge severity of symptoms and then again later to give guidance to response to treatment.

There are 20 symptoms listed here. You judge the severity of your own symptoms and record the score - 0 for none, 1 for mild, 2 for moderate, 3 for severe.

(Modified Greene Scale)


Section 1: Demographics