Self-Assessment: Abnormal Uterine Bleeding Tell Us About Your SymptomsDo you have to change your pads or tampons more frequently than every 2-3 hours?* Yes No Do you pass clots?* Yes No Do your periods last longer than 5-7 days from start to finish?* Yes No Have your periods become progressively longer or heavier over the years?* Yes No Do you risk soiling or leakage if you can't change sanitary products in time?* Yes No Do you find yourself limiting your activities during the time of your flow due to its heaviness or pain?* Yes No Do you feel drained during your period or have you been told that you are anemic?* Yes No Tell Us About YourselfName* First Last Phone Number*Email Address* I would like to receive a call to schedule a consultation with Dr Jones:* Yes No Is it urgent? Contact our office to schedule an appointment! Is it REALLY urgent? Call 911.