Iron Screener
The Iron Risk Screener

Iron & Glow Risk Screener

Check all systemic risk factors and physiological indicators that apply to your health profile. Your responses help generate a personalized recommendation to share with your provider.

Part 1: Systemic Risk Factors & Physiology
Part 2: Cycle & Clinical History

How would you describe your monthly menstrual cycle?

Have you previously been told your bloodwork or iron was "normal" despite feeling symptomatic?

Do you have any history of gastrointestinal conditions (like IBS, GERD, or frequent stomach upset)?

Part 3: Quality of Life & Functional Impact

Social & Work Impairment: Does your menstrual flow regularly force you to miss school, leave work early, or cancel social activities?

Anxiety & Preparedness: Do you experience significant anxiety about bleeding through your clothes or feel forced to carry extra clothing to avoid staining?

Physical Fatigue Impact: Does severe exhaustion during your cycle stop you from completing normal daily chores or exercising?

Clinical Bridge Document

Initiative: Iron & Glow | Quality Care For All Inc.

To the attending Healthcare Provider:
The patient presenting this document has completed a standardized clinical screening designed to identify heavy menstrual bleeding (HMB) associated with systemic iron depletion. Because early-stage iron depletion often presents with "normal" hemoglobin levels, we are requesting a specific Serum Ferritin test alongside a Full Blood Count (FBC).

Patient Self-Reported Screening Results:

1. Systemic Risk Factors & Symptoms Identified:

    2. Cycle & Clinical History:

      3. Quality of Life & Functional Impact:

        This document is generated via the Iron & Glow community health navigation initiative. This screener serves as an educational tool to bridge the diagnostic gap in HMB-related iron deficiency and is not a clinical diagnosis.