Vaginal Rejuvenation Survey

Is this treatment right for YOU?

Select all that may apply.

Do you notice vaginal discomfort symptoms on a regular basis?

Are you experiencing menopause or peri menopause symptoms?

Have you had multiple births?

Have you been through Cancer treatment?

Do you choose not to (or cannot) use estrogen/hormone therapies?

Have you been told you have low estrogen?

Are you experiencing urinary problems?

Do your symptoms affect: sleep, activity, athletics, travel and social activities?

Would you like to be able to have sexual relations without discomfort?

Are you experiencing dryness, itching, discharge, odor, irritation, tenderness?

Are you experiencing loss of elasticity and wrinkled appearance of the labia and vulva?

Would you like to revitalize your vaginal area?

Name *

First Name

Last Name