Women helping Women understand PMDD & ending the stigma of Women only disorders
1.Your Name:
First____________________________
Last (if comfortable)if not, just First________________________________
2.Your Age: Please choose: ________________
(15-18) (19-24) (25-29) (30-34) (35-39) (40-44) (45-49) (50-54) (55-59) (59+)
3.When did your symptoms begin? ___________________
(1)From the beginning of your cycle, as a teen
(2)after having children
(3)more as an adult
(4)other:please explain
4. Do you take medication? If so
… ContinueCreated by Stef Jun 26, 2009 at 6:34pm. Last updated by Stef Jun. 27, 2009.
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Created by Stef Jun 17, 2009 at 6:40am. Last updated by Stef Jun. 17, 2009.
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