Screening Tool Appointment

I just got diagnosed

3 - 6 months

6 months - 1 year

1 - 2 years

2 - 5 years

More than 5 years

Metformin

Oral contraceptive pills

Dieting

Exercising more

Tried Ayurveda / Homeopathy

None of the above

1 (Did not work)

3 (Not sure)

5 (Worked perfectly!)

In the last 6 months, how many days have gone by between your periods on average?*

How many years has it been since you had your FIRST period?*

How did you find out about us?*

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Do you have PCOS?

When would you like to start treatment?

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Date	Time