You don’t realize how lousy you feel until you feel better, and you can’t imagine how great you’re going to feel! This questionnaire will help us determine the current state of your digestive and hormone health and ways to improve it! Our goal is to understand specific issues that are affecting your overall health and your ability to not only lose weight, but maintain it. You are going to be resetting your hormones using a 4-Pillar System that will be explained.

Please rate each item 1-10
BEFORE beginning your program.

1 means you never experience this symptom
10 means you experience this all the time or take medication for it.