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?*YesNoDo you pass clots?*YesNoDo your periods last longer than 5-7 days from start to finish?*YesNoHave your periods become progressively longer or heavier over the years?*YesNoDo you risk soiling or leakage if you can't change sanitary products in time?*YesNoDo you find yourself limiting your activities during the time of your flow due to its heaviness or pain?*YesNoDo you feel drained during your period or have you been told that you are anemic?*YesNoTell Us About YourselfName* First Last Phone Number*Email Address* I would like to receive a call to schedule a consultation with Dr Jones:*YesNo Is it urgent? Contact our office to schedule an appointment! Is it REALLY urgent? Call 911.