Dr. Donnica's Healthy Women Over 40 Decisionnaire

If you are a woman over age 40 and if any of the following items can be checked, it's time to schedule your next doctor's appointment!

___	I have not had a check-up in more than a year.
___	I have not had a Pap smear in more than a year.
___	I have not yet had a mammogram.
___	I have not had my blood pressure checked in more than a year.
___	I have not had my cholesterol tested in more than 3 years.
___	I am not comfortable with my choice of contraception.
___	I am a smoker and I need help to quit.
___	I have not had a pelvic exam in more than a year.
___	I have not had a rectal exam in more than a year.
___	I have not had a breast exam in more than a year.
___	I feel anxious or depressed much of the time.
___	I feel like I am starting to have symptoms of menopause.
___	I have problems getting to sleep or staying asleep.

Click here for more information on staying healthy.

Click here for more information about depression or other mental health issues.

Created: 9/22/2000  -  Donnica Moore, M.D.