Women across life stages representing perimenopause, menopause, and hormone wellness care.

Bioidentical Hormone Replacement Therapy (BHRT)

This custom approach safely restores balance and improves well-being.

Before you start

This intake takes about 8–10 minutes. Your answers are private and stored securely. You can stop and come back later — your progress is saved automatically.

Most questions are simple Yes/No. If you're not sure of an exact date or number, your best estimate is fine.

Secure & private

Saves automatically

Reviewed by a physician

About You

Basic info

We use this to set up your chart and contact you about your consultation.

First name* Please enter your first name

Middle name (optional)

Last name* Please enter your last name

Date of birth* Please enter a valid date of birth (must be 18+)

Age

—

Calculated automatically

State* MetaHer™ currently serves Florida residents only

Height*

e.g., 5 ft 4 in Please enter a valid height

Weight (lb)* Please enter your weight

BMI

—

Calculated automatically

Email* Please enter a valid email address

Mobile phone* Please enter a valid 10-digit US phone number

Your Periods

Period & pregnancy history

These questions help us understand where you are in the menopause transition. Your best estimate is fine.

Age of your first period When you first started getting periods

Number of pregnancies Include miscarriages

Number of live births

Are you still having periods?*

Yes No Irregular

When was your last period?

Approximate date is fine — leave blank if you don't remember

Have you had a hysterectomy (surgery to remove your uterus)?*

No Yes Not sure

Year of surgery

Reason (if you remember)

Have you had your ovaries removed?*

No One ovary removed Both ovaries removed Not sure

How Are You Feeling?

Your symptoms

Rate each symptom over the past 4 weeks. There are no right or wrong answers — be honest about how things have been.

NoneMildModerateSevereVery Severe

Bleeding History

Important to share

Check any that apply. These help us decide if any tests are needed before starting hormone therapy.

Bleeding or spotting after my periods stopped (12+ months without a period) Very heavy or long periods recently Bleeding or spotting between periods Bleeding after sex Abnormal pelvic ultrasound or biopsy in the past year Pap test in last 3 years (normal) Mammogram in last 12 months (normal) Bone density scan (DEXA) in last 24 months

Your Health History

Things we need to know

Check any condition you've had — even years ago. This helps us choose the safest hormone option for you.

Have you ever been diagnosed with any of these?

Breast cancer Cancer of the uterus or ovaries Blood clot in leg or lung (DVT or PE) Heart attack, stroke, or "mini-stroke" (TIA) A blood clotting disorder Severe liver disease Unexplained vaginal bleeding I am pregnant or might be pregnant

Do any of these apply to you?

Migraines with vision changes Very high triglycerides Gallbladder disease or gallstones Uncontrolled high blood pressure Diabetes with eye, kidney, or circulation problems I currently smoke Uterine fibroids or endometriosis Abnormal breast biopsy in the past

Other ongoing conditions:

Have you had any other major surgeries?*

No Yes

Please describe (year and type)

Do you have any allergies?*

No Yes

Please list your allergies

Family Health

Mother, sisters, daughters

Check anything that has affected your close blood relatives (mother, sisters, or daughters).

Medications & Lifestyle

A few quick Yes/No questions. We'll only ask for details if you answer Yes.

Do you take any prescription medications?*

No Yes

Please list them (name and dose)

Do you take any vitamins, supplements, or weight-loss medications?*

Includes Ozempic, Mounjaro, Zepbound, etc.

No Yes

Please list them

Have you ever taken hormones? (birth control pills, HRT, hormone IUD, testosterone)*

No Yes Not sure

What and approximately when?

Do you smoke (cigarettes, vape, etc.)?*

No Used to, quit Yes

Do you drink alcohol?*

No Occasionally Weekly Daily

Do you use cannabis (marijuana)?*

No Occasionally Regularly

What You're Hoping For

Your goals

Check anything you'd like to feel better about. We'll prioritize these in your treatment plan.

Anything else you'd like Dr. Falcon to know?

No Yes

Tell us

Recent Lab Results

Optional

Have you had blood work done in the last 6 months?

No Yes

Upload them now (PDF or photo) or enter the values you remember below. If you skip both, Dr. Falcon will tell you which tests to get.

Where were the labs done?

When were they drawn?

Hormone values you remember (all optional):

FSH (mIU/mL)

Estradiol / E2 (pg/mL)

LH (mIU/mL)

Progesterone (ng/mL)

TSH (mIU/L)

HbA1c (%)

Vitamin D 25-OH (ng/mL)

Total Testosterone (ng/dL)

hs-CRP (mg/L)

Upload your lab PDF or photo

Tap to choose · PDF, JPG, PNG · Up to 5 files

Consent & Submit

Almost done!

Once you submit, Dr. Falcon will personally review your answers and your personalized Plan of Care will be emailed to you within 1–2 business days.

Thank you

Your intake has been submitted securely.

Dr. Falcon will personally review your answers and your individualized Plan of Care will be sent to your email within 1–2 business days.

No further action needed on your part.

Something went wrong

We couldn't generate your plan. Your answers have been saved on this device — please try again.

Hot flashes or sudden warmth
Night sweats — waking up sweaty
Heart racing or skipping beats
Trouble sleeping
Feeling sad or tearful
Irritability
Anxiety or feeling on edge
Exhaustion or brain fog
Low sex drive or pain during sex
Bladder issues — urgency, leaking
Vaginal dryness or discomfort
Joint or muscle aches
Headaches or migraines
Skin or hair changes
Weight gain — especially belly
Breast tenderness