"*" indicates required fields

Contact a Nurse Advocate

Please complete this questionnaire to help our nurse advocates understand your specific concerns and evaluate your options.

Have you experienced any of the following symptoms?
(Check all that apply)
Which of the following abnormal period symptoms have you experienced?
(Check all that apply)
Please answer in your own words, skip if you don't feel comfortable sharing.
This field is hidden when viewing the form
On your heaviest days, how often do you need to change your pads or tampons?
This field is hidden when viewing the form
Has a healthcare provider ever told you or a family member that you have an enlarged uterus or fibroids?
This field is hidden when viewing the form
Please answer the rest of the questions as if you are the person who has been told they have an enlarged uterus or fibroids.*
How long have you had symptoms?
How significantly do your symptoms impact your life?
This field is hidden when viewing the form
How would you rate your level of frustration with your symptoms?
This field is hidden when viewing the form
How many different physicians have you discussed your symptoms with?
Has a physician suggested any of the following procedures/treatments as a treatment for you?
(Check all that apply)
Please answer in your own words. Skip if you don’t feel comfortable answering or if you don’t remember.
What is your primary reason for seeking more information about Sonata?
This field is hidden when viewing the form
Please answer in your own words. Skip if you don’t feel comfortable answering.
Are you currently pregnant?*
This field is hidden when viewing the form
Do you have Essure for sterilization?*
This field is hidden when viewing the form
Opt-In*
FRM 05195-002 Rev D
This field is for validation purposes and should be left unchanged.
  • _gravity_form_modal
  • About Fibroids
  • About Sonata System
    • Clinical Education and Publications
    • Education Resource Center
      • Education Resource Center – Enter
        • Office / Practice Support
        • Patient Education
        • Physician Training
        • Social Media Content
    • FAQ for Healthcare Professionals
    • SMART OS 2.4
  • Blog Posts
  • Brochures
  • Comprehensive Woman’s Care
  • Contact Us
    • Allan Ruby, MD
    • Ana Perry, MD
    • Anthony Iwuagwu, MD
    • Arnita Reed, MD
    • Brian Raybon, MD
    • Careers
    • Contact Us – HCP Inquiries
    • Contact Us – Sonata Patient Support
    • Dina Kassab, DO
    • Find a Doctor
    • Gregory Reynolds, MD
    • Habeeb Bello, DO
    • Hillary Robinowitz-Elins, MD
    • Hsin Wang, MD
    • Jessica Van Kooten, DO
    • Kathy Jones-Caillouet, MD
    • Keith Ramsey, MD
    • Kelly Wright, MD
    • Kinnari Desai, MD, FACOG, MPH
    • Landing Page-Facebook
    • Marjorie Michel, MD
    • Matthew Tipton, MD
    • Megan Russell, MD
    • Meredith Martin-Johnston, DO
    • Micah Garb, MD
    • Michael Linton, MD
    • Michael Stine Jr., DO
    • Nidhi De, MD
    • Perkin Stang, MD
    • Peter Khamvongsa, FACOG, FACS, IF
    • Prinn Stang, DO
    • Ram Parvataneni, MD
    • Rene Perez, MD
    • Salvatore Finazzo, DO
    • Sawsan Jamil, MD
    • Sophia Addy, MD, MPH
    • Tarryl Jenkins, MD
    • Tiffany Wilson, MD
    • Valentin Drezaliu, MD
    • Vida McGhee-Lewis, MD
    • Young Yoon, DO
  • Copy of Home – For Hologic Announcement
  • Customer On-Boarding Form
  • Dinner Invitations ACOG 2024
  • Dr. Durowade-Dardur Medical
  • Employee Suggestion Form
  • Fibroid Symptom Questionnaire
  • For Physicians Test Page
  • Frequently Asked Questions
  • Home
  • Impressum
  • NP Ad Landing Page
  • Patient Consent and Release Form
  • Patient Event: Cherry Hill, NJ
  • Patient Event: Lexington, KY
  • Patient Resources
    • Patient Events
  • Physician Webinars
  • Privacy Notice
    • Cookie Notice
    • Limit the Use of My Sensitive Personal Information
  • Safety Information
  • Sonata and Acessa
  • Sonata Insights Newsletter
  • Sonata Success Stories
  • Sonata Treatment Landing Page
  • Success
  • Terms of Use
  • The SMART Way to Treat Fibroids: Educational Event ACOG 2024
  • Virtual Patient Event with Dr. Durowade
  • Why Sonata?
  • Thank You Form Submission Redirect
Gynesonics, Inc.600 Chesapeake DriveRedwood City, CA  94063
Copyright 2025 Sonata Treatment