Hormone Imbalance Screening Quiz

Streamline Hormone Health Assessments with This Comprehensive Screening Quiz

For integrative medicine practitioners, naturopaths, and functional medicine doctors, identifying hormone imbalances requires gathering detailed information about symptom patterns, lifestyle factors, and health history. This Hormone Imbalance Screening Quiz template gives you a professional, thorough assessment tool that evaluates patients across multiple hormone systems while providing actionable testing protocol recommendations.

Designed for Holistic Hormone Health Practices

This template helps practitioners efficiently screen for thyroid dysfunction, adrenal fatigue, estrogen dominance, testosterone imbalance, and other hormonal issues through a structured questionnaire covering physical symptoms, menstrual patterns, energy levels, stress indicators, and lifestyle factors. The quiz uses conditional logic to ask relevant follow-up questions based on patient responses, creating a personalized assessment experience.

Why Paperform for Patient Assessments

With Paperform's doc-style editor, you can customize this template to match your practice's brand while maintaining a professional, easy-to-navigate patient experience. The platform's calculation engine can automatically score symptom severity across different hormone systems, helping you quickly identify which panels to prioritize for testing.

Automate your follow-up workflow by connecting this form to Stepper, your AI-native automation platform. Automatically send assessment results to your practice management system, trigger personalized email sequences with pre-test instructions, or create tasks for your clinical team to schedule lab work—all based on the patient's specific responses and calculated risk scores.

Complete Patient Care Integration

Use this screening quiz as part of your new patient intake process, or offer it as a standalone assessment for existing patients experiencing unexplained symptoms. The form can integrate with your CRM, EMR, or project management tools to keep all patient data organized and accessible. You can even collect payment for comprehensive hormone panels directly through the form using Stripe, PayPal, or Square integrations.

Whether you're building a functional medicine practice, expanding your integrative health services, or looking to provide more structured hormone health assessments, this template gives you a professional foundation that saves time while delivering thorough, personalized patient care.