Women's Health & Vitality 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".


(Difficulty falling asleep, sleeping through the night, or waking up too early

Note: Please add up your score and enter it below.

Vitality Score: Mild (1-20) / Moderate: (21-40) / Severe (41-60) / Very Severe: (61-80)