Elena Wagner, MD


Teresa, a Sonata Nurse Advocate, is available to answer questions about fibroid treatment options.
Submit the questionnaire below or call Teresa at: 650-540-8814.

Virginia Mason Medical Center
1100 Ninth Avenue
Seattle, WA 98101 [Map]

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Contact a Nurse Advocate

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

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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)
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On your heaviest days, how often do you need to change your pads or tampons?
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Has a healthcare provider ever told you or a family member that you have an enlarged uterus or fibroids?
How long have you had symptoms?
How significantly do your symptoms impact your life?
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How would you rate your level of frustration with your symptoms?
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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)
What is your primary reason for seeking more information about Sonata?
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Please answer in your own words. Skip if you don’t feel comfortable answering.
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Are you currently pregnant?*
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Do you have Essure for sterilization?*
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FRM 05195-002 Rev D
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