Menopause Symptoms - Greene Scale

If you have been advised by the surgery to submit a Menopause symptom review please use this form. The Greene Scale provides a brief measure of menopause symptoms. It can be used to assess changes in different symptoms, before and after menopause treatment.

Your Details

Name *

Date of Birth *

Phone Number

Email Address *

Menopause symptoms

Please indicate the extent to which you are bothered at the moment by any of the following symptoms

The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.

I confirm the information I’ve given is correct and I understand how it will be used

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the The Brimington Surgery website

Menopause Symptoms - Greene Scale

Further Information