Day 7 symptom check in
Hey there - by now you should be at day 7 of our program. And this check in is designed to do just that - to check in on how you're doing in order to capture impact but also to enable us to explore how we may able to help you more. Looking forward to assessing progress with you
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Who is your Wellness Specialist?
*
Jessica Robinson
Lisa Stern
Lea Koeka
Please confirm which product(s) from the MPOWDER range you will be taking for 30 days? Please check all that apply.
*
Peri-Boost
Meno-Boost
Gut- Instinct
Mood-Food
Using a scale of 0-6 where 0 is 'not at all' and 6 is 'extremely bothered by,' please pick a score for the severity of the following symptoms over the last 7 days
1. Feeling tired
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
2. Feeling anxious
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
3. Difficulty sleeping
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
4. Feeling bloated
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
5. Weight maintenance
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
6. Hot flashes
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
7. Low mood
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
8. Low libido
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
9. Indigestion
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
10. Gas
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
11. Food cravings
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
12. Constipation
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
13. Aching muscles and joints
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
14. Brain fog
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
Additional Symptom (ex: vertigo, burning tongue etc)
*
Not at all bothered
0
1
2
3
4
5
Extremely bothered
6
0 is Not at all bothered, 6 is Extremely bothered
What additional symptoms are you tracking?
*
14. Finally, have you noticed a difference in your skin, hair or nails in the last week? If so, please tell us what you have observed.*simply answer 'no' if not applicable
*
Submit
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