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Women Laughing on Couch

Questionnaire 

When we meet our clients - taking an interest can make them feel listened to and valued. Keeping the conversation structures helps keep the initial conversation structured and professional. 

Fill out the questionnaire below - this is a personal assignment. Be honest with yourself. 

We can't expect our ladies to complete a form we haven't! 

Birthday
Día
Mes
Año
Children?
Yes
No
Have you reached menopause?
Have you had a hysterectomy or oophorectomy?
Oophorectomy
Hysterectomy
Are yo currently using any menopause related treatment or therapies?
Which of the following symptoms are you currently experiencing? (check all that apply)
What kind of support are you looking for from a Menopause Doula? (check all that apply)
Are you interested in:

Questionnaire

Escuela de Atención Prenatal Ltd.
Reg.: 14260658
Directores: Dawn Rosevear - Matthew Pearce
Dirección registrada: Suit 1 -Pollox Gate FY8 1BG

 

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