PRELIMINARY HORMONE ASSESSMENT

PRELIMINARY HORMONE ASSESSMENT
This questionnaire is a tool designed to help determine if you may be suffering from a hormone imbalance, and if so, which hormone in particular needs to be addressed.

Instructions:
- Assign 1 point for each ‘yes’ answer in all sections.
- Once completed, tally up your points for a total score for each section (i.e. Section 1 – Part A = score and Section 1 - Part B = score. Don’t combine parts A and B scores together).
- Submit the completed assesment with your name & email for a response from Sonia Issa.
Name

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
SECTION 1

Part A)

Do you have or have you experienced in the past 6 months…
A sense of constantly racing from one task to the next?Feeling both wired and tired?Struggling to calm down before bedtime or experiencing a late-night energy surge?Difficulty falling asleep or disruptions in sleep patterns?Persistent anxiety or nervousness – can’t stop worrying about things beyond your control?A quickness to feel anger or rage – frequent screaming or yelling?Memory lapses or feeling distracted, especially under pressure?Cravings for sweets, particularly after meals?Increased abdominal circumference, greater than 35 inches (abdominal fat or muffin top – not bloating)?Skin conditions such as eczema or thin skin?Signs of bone loss, including osteopenia or osteoporosis?Instances of high blood pressure or rapid heartbeat unrelated to exciting situations?High blood sugar (your doctor may have used the term prediabetes or diabetes or insulin resistance)?Hangry between meals - shaky between meals also known as blood sugar instability?Indigestion, ulcers or GERD (gastroesophageal reflux disease)?Increased difficulty recovering from physical injury than in the past?Unexplained pink to purple stretch marks on your belly or back?Irregular menstrual cycles?Decreased fertility?
SECTION 1: Part A - Total Score:
SECTION 1

Part B)

Do you have or have you experienced in the past 6 months…
Fatigue or burnout, relying on caffeine for energy or dozing off during activities?Reduced stamina, particularly in the afternoon, from 2p.m. to 5 p.m.?A tendency to a negative point of view?Emotional meltdowns or crying for no particular reason?Decreased problem solving ability?Feeling stressed most of the time (everything seems harder than before)?Diminished stress tolerance?Insomnia or difficulty staying asleep, especially between 1 a.m. and 4 a.m.?Low blood pressure (your blood pressure determines the correct amount of oxygen to send everywhere especially into your brain)?Feel dizzy when move from a seated or lying position to standing?Weakened ability to fight infections (feel like you catch every virus)?Prolonged recovery from illness or surgery or healing wounds?Asthma? Bronchitis? Chronic cough? Allergies?Low or unstable blood sugar?Salt cravings?Excess sweating?Nausea, vomiting or diarrhea? Or loose stool alternating with constipation?Muscle weakness, especially around the knee?Muscle or joint pain?Hemorrhoids or varicose veins?Your blood seems to pool easily or your skin bruises easily?A treated thyroid problem leading to palpitations or irregular heartbeats?
Section 1: Part B – Total Score:
Click SUBMIT if you would like Sonia Issa to interpret your results and share tips/resources with you to help you get on the right track.

***MAKE SURE YOU HAVE ENTERED YOUR NAME & EMAIL AT THE TOP to receive an email reply from Sonia.
Interpreting Your Scores

If you scored…

5 or more in either Part A or Part B = RED ALERT!

Your hormones need rebalancing.

Regulating and balancing hormones usually takes between 3 to 6 months, but you can expect to see and feel results within the first two weeks of us working together.

Join our free private Facebook group, Radiant Heartspace Wellness Collective for resources to kickstart your hormone-balancing journey.

If you are looking for further suppport (because you want to feel incredible inside & out), Strong Again Body & Soul is a 12 week hormone balancing and holistic fitness program that is fully customized to you! Taking this action will allow you to optimize your hormones, increase mental clarity, BE fully energized, EmBODY confidence, look & feel Strong Again. You will mindfully lose fat for good without counting calories, cravings or endless cardio. Not to mention the great side effect of droping 4-6 sizes.

3 – 4 in Part A or less than 5 in Part B = Your hormones may need support.

This is a preliminary hormone assessment so your hormones very well may need support or their may be internal imbalances causing your body to remain in fat storing mode and struggling with symptoms.

Instead of guessing, let's test! Saliva Hormone Testing & 1:1 Results Reading will help us determine what is happening with your body at a hormonal level and get you started on your hormone balancing journey so you can get back to feeling like your happy, strong & confident self again!
Any questions? Connect with me via Instagram DM or send an email to sonia@radiantheartspace.com

Coach Sonia
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