EaseMD Pre-Intake Quiz Funnel – Initial Questions

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1. Let’s Start With You* This field is required.How old are you? This helps us understand where you might be in the menopause transition.

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2. Have You Felt Any of These Lately?* This field is required.Which of these symptoms sound familiar? These are just a few of the 100+ symptoms linked to hormonal changes.

Hot flashes

Sleep issues

Low libido

Mood swings

Weight gain

Brain fog

Fatigue

None of these

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3. How Long Has This Been Going On?* This field is required.When did these symptoms begin?

Less than 1 year

1–3 years

Over 3 years

I’m not sure

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4. You’re Not Imagining It…* This field is required.Hormone changes can trigger over 100 symptoms — from memory lapses and joint pain to weight gain and fatigue. Did you know this?

Yes, I know

No, I didn't

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5. Have You Ever Heard of Hormone Therapy?* This field is required.Are you familiar with bioidentical hormone replacement therapy (HRT)? Many women are surprised to learn it supports both symptom relief and long-term health.

YESNO

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6. Want to Get Your Personalized Results?* This field is required.Enter your email to find out how your symptoms match with EaseMD’s treatment options. 🔒 We’ll send your results and never share your info.

example@example.com

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