• Hormone Evaluation (Female) Intake Form

  • Height: feet    inches
    Weight: pounds

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  • Additional labs desired to help in your consultation:

    • Blood sugar and A1c
    • Lipids/cholesterol or Spectracell Cardiometabolic Profile
    • Iron/blood count (ferritin)
    • Micronutrient test from Spectracell
    • Vitamin D
    • Vitamin B12
    • TSH, Free T4, Free T3, TPO and Thyroid Antibodies (& Reverse T3)
    • Fasting insulin
    • CRP
    • Homocysteine

    Hormone Panel

    • Estriol, estradiol, estrone
    • Progesterone
    • Testosterone
    • DHEA
    • Cortisol (morning, afternoon, evening, and bedtime)
  • Should be Empty: