FREE PCOS Health Quiz

You are amazing my friend! Great job taking your health into your own hands by filling out this quiz.

This form is strictly confidential between you and me. I will never share or sell this information. Please be as honest as possible so I can make the right recommendations for you and your health goals.

To ensure you receive your personalized suggestions, please add katie@thepcosnutritioncoach.com to your contacts list.

PLEASE NOTE: Due to popular demand, I am only able to go over the submissions & send custom tips every Wednesday. The answers you receive are not automated and I spend time going over each submission to make sure I am giving you relevant advice.

If you don't receive your response within 7 days from the date you submitted this, please message me on Instagram @the.pcos.nutrition.coach or email me at the address above.
Name*

First NameLast Name
Email*
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EmailInstagram Messenger
If Instagram messenger, leave your Instagram username & be sure to check your message request folder frequently:
What country do you currently reside in?*
How old are you?*
What is your height in feet & inches?*
What is your current weight in pounds?*
What is your goal weight in pounds? It's okay if you do not have a goal weight or weight loss is not your goal just put n/a.*
PCOS (Poly Cystic Ovarian Syndrome)EndometriosisThyroid IssuesInfertilityOther
Lose weightGain healthy weightBuild lean muscleIncrease energyWork on mindsetGet fitIncrease activityImprove digestive healthDecrease inflammationReduce painSupport a healthy pregnancyImprove sleepReduce stressManage PCOS symptomsDevelop healthy eating habitsRepair relationship with foodWork on body positivity
I don't know what FOODS TO EAT to manage my PCOS symptomsI don't know how to MEAL PREP or create an effective PLANI don't know what SNACKS I should eat on the go that are healthyI struggle with fitting in EXERCISE or ACTIVITY into my busy dayI struggle with MINDSET and my RELATIONSHIP with FOODI struggle with LOW ENERGYI struggle with DIGESTIVE HEALTH (bloating, constipation, indigestion, diarrhea, etc)I struggle with very strong FOOD CRAVINGSI don't know how to TRAVEL and stick to a balanced, PCOS friendly planI want to have fun with my LIFE but not eat foods that make my symptoms worseI don't know enough EASY RECIPES or healthy recipes to make in large quantities for my familyI am a PICKY EATERI want to LOSE WEIGHT but NOTHING seems to workI don't know how to get started with WORKING OUTI don't know what HEALTHY SWAPS to make at popular RESTAURANTSI want to spend less MONEY on foodI want to stop eating ALL THE THINGS late at nightOther
What would you say is your biggest struggle with improving your health/PCOS symptoms?*
On a scale of 1-10, how serious are you about achieving your health goals?*

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1 is Not Serious, 10 is Very Serious
Do you have any food allergies OR sensitivities? *
Are you on any medications? Please list them here.*
Are you currently taking any vitamins, supplements or herbal remedies? Please list them here.*
Do you have any eating disorders, disordered eating patterns, or bingeing behaviors that you struggle with?*
Irregular periodsPainful periodsHeavy periodsAcneHirsutism (facial hair)Hair lossStubborn weight lossWeight gainFatigue (tiredness)Back painPelvic painMigraines or regular headachedPain during bowel movements or intercourseInfertilityMiscarriage(s)BloatingIndigestionDiarrheaConstipationNauseaDepressionAnxietyMood SwingsADHD or ADD (received diagnosis)Other
If I could wave a magic wand and help manage ONE of these symptoms for you, what would it be?*
How many times per day do you eat?*
What do you eat for breakfast currently?*
What's your food weakness (if you have one)?*
How much water do you drink (in ounces)?*
Inactive (do not do any activity)Mildly active (active 1 x per week)Moderately active (active 3-4 times per week or work mostly on my feet)Active (active 4-5 times per week)Very Active (active 6 or more times per week)
Do you have any physical limitations, health conditions, injuries, or disabilities that limit your physical activity?*
What do you do for a living? Are there any challenges with what you do and achieving your health goals (ie shift work, irregular hours, etc)?*
How many hours of sleep do you get on average?*
What would you rate your current stress level? 1 as SUPER stressed, 10 as care free.*

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1 is Worst, 10 is Best
Please share how many people are in your household and their relationship to you. Would you consider the people you live with supportive of your goals? Feel free to elaborate.*
Why do you want to achieve your health results?*
Is there anything you are afraid of regarding your health?*
What have you tried before to achieve your health goal? Why didn't that work for you?*
What is the one habit you would like to change the most?*
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If you follow me on Instagram/Facebook @the.pcos.nutrition.coach are there any specific topics & content would you like to see more of from me?
Thank you! I know answering these questions isn't always easy, and I appreciate your honesty so that I can really get to know you and identify what areas you struggle with.

You will receive your personalized tips via email within approximately 48 hours.

If you have any questions about your results or would like more info on how to work with me, DM me on Instagram or shoot me an email. I would love to hear if the tips were helpful for you!

I can't wait to support you in your health journey and have zero doubts you will reach those goals with me and my supportive community to guide you and encourage you every step of the way.
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