Let's get started
How long have you been
experiencing vaginal symptoms?
Dryness
Does it feel like there is a lack of moisture or like the skin is sticking together?
How severe is it? Select one.
Soreness
Is your vagina or vulva sore or uncomfortable with ordinary daily activities like walking
and exercise?
How severe is it? Select one.
Irritation
Do you ever have a burning or itching sensation in your vagina or vulva?
How severe is it? Select one.
Pain with sex
Do you experience discomfort, pain, or bleeding during or after sexual activity or touch?
How severe is it? Select one.
Urinary health
Have you had more than three urinary tract infections in the last year?
Urinary health
Do you have more urgency to pee?
Other urinary symptoms
Are you experiencing any other urinary symptoms that your doctor should be aware of?
Why can't I proceed? You haven't reported any
symptoms related to vaginal atrophy. Please go back and check that you have reported
your
symptoms.
Urinary health
Would you like to have your urinary symptoms evaluated to determine if you currently need
treatment for an active UTI?
Got it!
We'll evaluate your symptoms for an active UTI at the end of this questionnaire.
Your last period
Hormonal shifts in perimenopause and menopause cause changes to the vulva, vagina, and
urinary tract.
When was your last period?
Do you experience any period irregularities?
Irregular periods may be a sign of perimenopause.
Select all that apply.
Have you had surgical removal of any of your reproductive organs?
Symptoms can be more acute in women who have their uterus and/or ovaries removed.
Select all that apply.
Other genital symptoms
Are you experiencing any other genital symptoms that your doctor should be aware of?
Have you tried any previous therapies to address your genital symptoms?
Please include names of any treatments, if they were
effective and if you experienced any side effects.
Pelvic exam
When was your last pelvic exam?
Physician check up
When was your last check up with a physician?
Pelvic exam
Were any abnormalities found on your last pelvic exam?
Have you had a mammogram in the past 2 years?
Some medical conditions may make it unsafe for you to use topical estrogen.
Have you had any of the following medical conditions?
Medical conditions
Do you have any other diagnosed medical conditions?
Please be sure to include any conditions
that may affect your genital health (or anything you
see a doctor for or take medications
for).
Medications
Are you taking any medications?
Medication allergies
Are you allergic to any medications?
Allergies
Are you allergic to any of the following ingredients?
Is the basic info in your health profile still accurate?
How is the vaginal estradiol working for you?
Vaginal bleeding
Vaginal bleeding outside of your normal menstrual cycle could indicate a serious condition
and should be assessed by an in-person examination from a primary care physician or
gynecologist. You will not be prescribed treatment until the condition is assessed.
Have you noticed any of the following symptoms? Select all that apply.
Pregnancy
Are you pregnant or planning to be pregnant?
Breastfeeding
Are you breastfeeding?
Cancer history
Do you have a history of breast, uterine, ovarian or endometrial cancer?
Cancer history
As someone with a history of breast, uterine, ovarian or endometrial cancer, has your
oncologist
counseled you about ?
Aromatase inhibitors
Are you taking any of the following aromatase inhibitor medications?
Part 2: Active UTI
Almost done! Next we'll evaluate your symptoms for an active UTI.
What urinary symptoms are you having?
Please read carefully. Select all that apply.
How many days ago did your urinary symptoms start?
How much distress/disruption of your daily activities are these urinary symptoms causing?
Have you ever had any of the following genitourinary issues?
Select all that apply.
Have you had any of the following?
Select all that apply.
Do you have a diagnosis of diabetes or a hemoglobin A1c >6.5%?
Does not include pre-diabetes.
What antibiotic did you take to treat your last urinary
tract infection?
How did you respond?
Have you had a urinalysis and/or urine culture done in the past year?
Is there anything else you think the doctor should know
about your urinary symptoms?
Do you understand all of the questions which were asked?
Same-day pickup
Choose a local pharmacy to pick up your medication.
Here's your first message to your doctor.
Please
introduce yourself and feel free to:
Here's a new message to your doctor.
Please feel free to:
- Ask any questions you have.
- List any medical problem you have which were not discussed above.
- Include anything else you would like the doctor to know.
Please acknowledge that you understand and agree to the following:
I have filled out a medical intake form that will be used by a board certified physician
that is licensed in my state to make a medical treatment plan for me.
I understand all the questions that have been asked of me.
The information that I have provided is accurate and complete.
I am the patient who is consenting to be evaluated for treatment.
The Title
The subtitle
What is your current weight?
What is your height?
Blood pressure
Understanding your blood
pressure is an
important safety factor. What is the most recent reading you have?
Vaginal dryness
Do you have a sensation of
dryness or
burning
in the vagina, difficulty with sexual intercourse?
Are you using a hormonal IUD?
Tobacco smoking habits
Are you using any tobacco products
Finish health profile
Got it!
Are you sure you'd like to proceed?
Vaginal estradiol can help treat vaginal and
urinary changes due to perimenopause and menopause. Would you still like to continue
with a consult? There's a chance you're not
a good candidate due to your age, and if so, we'll refund your medication fee, but not the consult fee.
We've sent a verification code to
We want to make sure it's you before we
start sending checkins from your medical provider. Please enter the code to continue.
Thank you for
verifying your phone! Next is email.
We've emailed you a code at .
Please
check your email and enter the code to continue.
Didn't receive a code? Please check your spam folder.
Re-send the email with the
code
Code re-sent to
!
or
Text/call (909) 378-6899 or email support@getinterlude for help
My care plan
Your care plan and prescription are just a few steps away.
What's
next?
Submit
photo of
a valid
driver's license
Meet your
providerGet
relief!
Why do we require a valid driver's license? A board-certified
physician licensed in your state
must review a valid driver's license before prescribing treatment.
Please ensure the information on your driver's license is
visible, is not blurry, and is well-lit.
Uploading... Please do not close this screen while
upload is in progress.
There was a problem with your
photo. Please try
uploading again. Max file size is 6MB
Choose photo... / Thank you!
or
Select a photo from your device or take a
photo of your driver's license. All photos are encrypted and accessible only
to clinical staff.or
Don't feel comfortable sharing a photo of your driver's license?
We'll
verify your info digitally instead. It only takes a few seconds.
There was a problem
verifying
your
info. Please share a driver's license instead. For help, email
support@getinterlude.com
or
call/text (909) 378-6899.
Today's summary
Get your prescription renewed for up to 1 year or 7 refills.
Vaginal estradiol
Prescription renewal (one-time fee)
Reviewed by a board-certified doctor. Prescription valid
for up to 1 year or 7
refills.
Payment method
The next step is to submit a new health
profile. By clicking "Pay and continue" you authorize us to continue shipping
refills at your selected frequency. Each refill is with free shipping.
Need help?
Call or text: (909) 378-6899
Email: support@getinterlude.com
Payment completed!
Summary:
We've sent a receipt to . Next step is to update your health
profile.
Loading your health profile...
Click here
if it does not load.
Please wait...