Go back to home page of the site Please enable JavaScript in your browser to complete this form.Answer these questions to so we can help you determine if the O shot is for you.Date / TimeDateTimeName *FirstLastEmail *Phone *What is your date of birth?When was your last menstrual period?Have you been through menopause?YesNoIf you are postmenopausal, are you on hormone replacement?YesNoAre you having issues with achieving orgasm?YesNoIs sex less enjoyable?YesNoDo you have vaginal dryness?YesNoHas your libido changed?YesNoWas there a time when sex was more enjoyable?YesNoDo you have bladder leaking?YesNoDo you have any children?YesNoIf yes, did you have any difficult deliveries or larger babies?YesNoDo you have lichen sclerosus?YesNoHave you had a GYN exam and Pap smear in the past year?YesNoDo you have any medical problems?YesNoIf yes, please list.Would you like to set up a Virtual consultation to see if the O shot is for you?YesNoCustom Captcha * = SUBMIT ← Back to home page of website
