Select option*

1. Do you experience painful periods?

2. Do you experience pain outside your period (pelvic, ovulation, lower back, legs)?

3. Bleeding patterns

4. Digestive symptoms (select all that apply)

5. Urinary symptoms

6. Energy & brain symptoms

7. Mood & nervous system

8. Have you ever been diagnosed with endometriosis or suspected of it?

9. How long have you been experiencing these symptoms?

10. Have you received a diagnosis of Endometriosis by a medical professional?

11. Have you previously had endometriosis surgery?

12. Are you currently using any hormonal treatment for endometriosis (Eg. the contraceptive pill, GnRH agonists (Zoladex, Leuprolide, Nafarelin), Progesin, etc.)? *