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Headache
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Vomiting
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Chest Pain
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Fevers
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Shortness of Breath
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Chills
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Change in Vision, Hearing, Smell, Taste
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Night Sweats
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Leg Swelling
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Erectile Dysfunction
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Nasal Problems
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Change in Bowel Habits
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Fainting
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Change in Bladder Habbits
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Falling
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Weight Loss or Gain? How much?
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Lost Libido
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Viginal Laxity
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Cough
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New Masses
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Heartburn
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New Skin Lesions
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Incontinence/ Leakage
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Rash
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Abdominal Pain
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Pain? Where
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Nausea
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Weaknees
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Arthritis
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Bleeding
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Bruising
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Depression
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Anxiety
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Memory Loss
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Mood Swings
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Have you had?
• • •
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Other Problems, questions or concerns:
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