Brain, Hormone & Body Health Quiz - Take Now to Get Your Score & Guide
Rate each symptom on a scale of 0-3, 0=None, 1=Mild, 2=Moderate, 3=Severe.
Your Name
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First Name
Last Name
What is your age?
*
Email address to send your results
*
example@example.com
1. Do you experience hot flashes and/or night sweats?
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0 Never
1 Occasional
2 Frequently
3 Much of the time
2. How would you describe your sleep patterns?
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0 Sleep well (7-9) restful
1 Occasional Trouble
2 Frequent Difficulty Falling and/or Staying asleep
3 Rarely Get a Good Night Sleep
3. Have you noticed increased anxiety and/or depression lately?
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0 No
1 Occasionally, Mild
2 Frequently, Moderate
3 Often, Severe
4. Do you often feel fatigue and/or dizziness?
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0 No, I don't
1 Occasionally
2 Frequently
3 Constantly
5. Have you experienced weight gain, especially around your abdomen, hips & thighs?
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0 None
1 Mild
2 Moderate
3 Significant
6. Do you suffer from muscle cramps, spasms or twitching?
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0 No
1 Occasionally
2 Frequently
3 Almost Daily
7. Have your experience a decline in your libido and/or increased pain with sex?
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0 Not really
1 Mild change
2 Moderately
3 Significantly
8. Have you been experiencing significant joint pain or stiffness?
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0 No
1 Occasional
2 Frequent
3 Constant
9. Are you experiencing skin or vaginal dryness?
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0 No
1 Mild/Occasional
2 Moderate/Frequently
3 Severe/Constantly
10. Are you experiencing cold more frequently and/or have cold hand and feet?
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0 No
1 Mild/occasional
2 Moderately/frequently
3 Severely/all the time
11. Have you been experiencing hair thinning or increased hair loss?
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0 No
1 Slight increase
2 Moderate increase
3 Severe/significant
12. Do you struggle with brain fog, memory issues or difficulty concentrating?
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0 No
1 Mild/Occasional
2 Moderate/Frequent
3 Severe/Constant
13. Do you have significant cravings for salty or sweet foods?
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0 No
1 Mild/occasional cravings
2 Moderate cravings
3 Severe/frequent cravings
14. If you still have a cycle, is it irregular and/or heavier than most (or was it when you had a period)?
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0 No it isn't or rarely was
1 Occasionally
2 Sometimes
3 Often
15. Do you experience constipation?
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0 No
1 Occasional
2 Often
3 Most of the time
16. Do you experience headaches and/or migraines?
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0 Rarely
1 Occasionally
2 Frequently
3 Almost Daily
17. Do you feel unusually stressed and/or have difficulty managing your stress levels?
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0 Rarely
1 Sometimes
2 Often
3 Much of the time
18. Have you noticed palpitations or an irregular heartbeat?
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0 No
1 Occasionally
2 Frequently
3 Almost Always
19. Do you have difficulty losing weight despite diet and exercise efforts?
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0 Not at all
1 Mild difficulty
2 Moderate difficulty
3 Significant difficulty
20. Have you been experiencing decreased motivation or feelings of apathy?
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0 No, I don't
1 Occasional
2 Frequent
3 Almost always
21. Have you noted recent changes in your level of irritability, indigestion or bloating?
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0 No
1 Occasional
2 Frequent
3 Most of the time
22. How long have you not felt your best?
*
3-6 Months
More than a year
Less than one year
Years
Other
23. Do you know your Vitamin D level?
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0-20 ng/mL
20-40 ng/mL
40-60 ng/mL
60-100 ng/mL
Don't Know
Total Score
Total Score Percentage
Total Score Text
Estrogen Deficiency
Estrogen Deficiency %
Estrogen Deficiency Text
Estrogen Dominance
Estrogen Dominance %
Estrogen Dominance Text
Progesterone Deficiency
Progesterone Deficiency %
Progesterone Deficiency Text
Hypothyroid
Hypothyroid %
Hypothyroid % Text
Cortisol Imbalance (high or low)
Cortisol Imbalance %
Cortisol Imbalance % Text
Vitamin D Deficiency
Vitamin D Deficiency %
Vitamin D Deficiency % Text
Magnesium Deficiency
Magnesium Deficiency %
Magnesium Deficiency % Text
Vitamin B Deficiency
Vitamin B Deficiency %
Vitamin B Deficiency Text
Iron Deficiency
Iron Deficiency %
Iron Deficiency % Text
Omega-3 Deficiency %
Omega-3 Deficiency
Omega-3 Deficiency Text
Submit
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