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Patient Info
Current Trials
Meet the Team
Sponsor/CRO
John Whitfield, MD
Patient Portal
Blog
Contact Us
Patient Info
Current Trials
Meet the Team
Sponsor/CRO
John Whitfield, MD
Patient Portal
Blog
Contact Us
As a full-service GYN office And research site, our facility includes:
Companies We have partnered with
Endometriosis Study
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Name
*
First
Last
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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2003
2002
2001
2000
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1931
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1925
1924
1923
1922
1921
1920
Phone
*
Date of last period
What do you currently use for birth control?
If you have had a mammogram please list date of most recent
If you have ever been pregnant please list date of deliveries (please include any dates for miscarriage or abortions)
Have you ever participated in a clinical trial before?
Yes
No
Please list all medications you currently take and what you take them for:
Have you had surgery for endometriosis
*
Yes, and my physician told me they found endometriosis
Not for endometriosis but I had surgery and they found endometriosis
I have not had surgery but my doctor told me that is what he/she believes is causing my pain
I have not been told I have endometriosis but believe that I may
From the beginning of one period to the beginning of the next period would you say that they are 21-35 days apart?
Yes
No
I am/have had (Check all that apply)
currently breastfeeding, pregnant or trying to become pregnant
less than 6 months post-partum, post-abortion, or post-lactation
moderate to severe pelvic pain or painful periods
had a hysterectomy
removal of my ovaries
major schizophrenia or bipolar disorder
major depression or PTSD episode in the last 2 years
previous suicidal attempts
tried Lupron, Myfembree, Orlissa, or DepoProvera for endometriosis and it did not help
undiagnosed bleeding
drug or alcohol abuse in the last 12 months
cancer (other than basal cell carcinoma of the skin)
bone conditions (osteoporosis, osteopenia, or other bone disease)
uncontrolled thyroid disease, parathyroid disease, anorexia nervosa
low trauma fractures, bilateral hip replacement, spinal surgery or spinal hardware, severe scoliosis
chronic pain conditions other than endometriosis
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