She's Not Done: Your Still Strong Health Assessment
Welcome! Please answer honestly to get your personalized health insights and plan.
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Section 1: Welcome & You
Full name
*
First Name
Last Name
Email address
*
example@example.com
What's your age?
Where do you live? (city/state)
Best phone number to reach you
Please enter a valid phone number.
Format: (000) 000-0000.
How did you find She's Not Done?
YouTube
Instagram
Facebook
A friend referred me
Google
Other
What made you join TODAY — what's going on right now?
What do you want to get out of this community?
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Section 2: Your Goals & Your Why
What are your top 3 goals right now?
When you picture feeling your best, what does that look like?
What's your "why" — the deeper reason behind these goals?
What have you already tried?
Clean eating/diets
Calorie counting
Intermittent fasting
Excessive cardio
Personal trainer
Hormone replacement therapy
GLP-1 medications
Supplements
Meal delivery
Nothing has really worked
Other
Of everything you've tried, what worked even a little — and what didn't?
What's your single biggest frustration with your body right now?
What are you most afraid of?
Losing muscle
Wrecking my metabolism
Failing again
Wasting money
Gaining it all back
Feeling worse than I do now
It being too complicated
Other
If nothing changes in the next year, how do you feel about that?
What would success look like 90 days from now?
On a scale of 1-10, 10 being you are highly motivated, how ready are you to make a change?
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Section 3: See It — Your Body Right Now
Current weight
Height
Waist/abdomen circumference at the belly button
Do you know your body fat percentage? If so, what is it?
Have you had an InBody or DEXA scan?
Yes
No
Upload your InBody or DEXA scan Or Smart Device info (OPTIONAL)
Upload a File
Drag and drop files here
Choose a file
Totally optional — but if you have a recent body composition scan, uploading it lets me give you a far more accurate read. A screenshot or photo works perfectly.
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How would you rate your energy on a typical day? (1-10)
When is your energy lowest during the day?
Morning
Mid-morning
Early afternoon
Evening
It's low all day
How would you rate your sleep quality? (1-10)
How many hours of sleep do you average per night?
How is your digestion?
Great
Okay
Frequently bloated
IBS/sensitivities
Constipation issues
It's a mess
Which symptoms are you currently experiencing?
Hot flashes
Night sweats
Brain fog
Mood swings
Anxiety
Low libido
Joint aches
Stubborn belly fat
Hair thinning
Fatigue despite sleep
Bloating
Water retention
Irritability
Trouble sleeping
None of these
How long have you been feeling "off" or stuck?
Less than 6 months
6-12 months
1-2 years
3-5 years
More than 5 years
How would you describe your stress level lately? (1-10)
Does your body respond to your effort the way it used to?
Yes
Somewhat
No not at all
What changed for you, and when did you first notice it?
How is your mood and mental clarity these days?
Do you retain water or feel inflamed/puffy?
Often
Sometimes
Rarely
Never
How often do you feel genuinely rested when you wake up?
Most days
Some days
Rarely
Never
Any other physical symptoms or changes you've noticed?
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Section 4: Metabolic & Hormonal History
What is your current menopause status?
Pre-menopausal
Perimenopausal
Menopausal
Post-menopausal
Not sure
At what age did your cycle change or stop, if applicable?
Are you currently on hormone replacement therapy (HRT)?
Yes currently
I have in the past
Never
Considering it
If yes or past, what type and how has it gone?
Do you have any thyroid conditions or history?
Hypothyroid
Hashimoto's
Hyperthyroid
No
Not sure
Have you had recent bloodwork/labs done?
Yes within 6 months
Yes within a year
Over a year ago
Never
Upload your recent bloodwork / labs (optional)
Upload a File
Drag and drop files here
Choose a file
Here's the honest truth: if you want me to include a blood lab analysis in your report, I need to actually see your labs. Upload a PDF, screenshot, or clear photo here. No labs, no problem — you can skip this and still get your full report and roadmap. But the lab analysis only happens if you share them with me.
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Has a doctor ever told you your labs are "normal" but you still feel terrible?
Yes
No
Do you know your fasting insulin or A1C levels?
Any history of insulin resistance, PCOS, or pre-diabetes?
Insulin resistance
PCOS
Pre-diabetes
Type 2 diabetes
None
Not sure
Family history of metabolic or hormonal issues?
Have you noticed changes in how your body stores fat?
Yes more belly fat
Yes overall
No change
Not sure
How would you describe your metabolism?
Fast
Normal
Slow
Feels broken
Have you been through significant hormonal events?
Pregnancy
Difficult menopause
Hysterectomy
Ovary removal
Thyroid surgery
None
Other
Do you experience cravings tied to your cycle or time of month?
Yes
No
Not applicable
Any autoimmune conditions?
How is your skin, hair, and nail health?
Great
Okay
Declining
Poor
Do you feel your hormones are working against you? (1-10)
Anything else about your hormonal or metabolic health we should know?
Have you ever worked with a doctor who really listened about these issues?
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Section 5: Medication & GLP-1 History
List any medications you currently take
List any supplements you currently take
Have you ever taken a GLP-1 medication (Ozempic, Wegovy, Mounjaro, Zepbound, etc.)?
Currently taking one
Have in the past
Never
Currently considering it
If you've taken one, what was your experience?
If you took one and stopped, what happened?
Did you lose muscle or feel weaker on a GLP-1?
Yes
No
Not sure
Not applicable
Have you considered GLP-1 or peptide support as part of a strategy?
Yes I'm very interested
Somewhat curious
Not sure
No, I'm already on one
How do you feel about using medication as a tool when done correctly?
Open to it
Cautious but curious
Prefer natural only
Unsure
Any allergies or adverse medication reactions?
Are you working with any other healthcare providers currently?
Have you explored peptides or other advanced metabolic tools?
Yes
No
What questions do you have about medications or peptides?
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Section 6: Rewire It — The Inner Game
When do you reach for food that ISN'T hunger?
Stress
Boredom
Reward
Loneliness
Celebration
Late night
After a hard day
Social situations
I don't really
Other
Other
Describe your relationship with food in one sentence
Do you struggle with all-or-nothing thinking? ("I already blew it, so...")
All the time
Sometimes
Rarely
Never
What time of day is hardest for you with food?
Morning
Afternoon
Evening
Late night
Weekends
What foods feel "out of control" for you?
When you go off track, what does that usually look like?
How do you talk to yourself when you slip?
Do you eat to manage emotions? (1-10)
What's your biggest mental block around food or your body?
How much does stress drive your eating? (1-10)
Do you feel guilt or shame around food?
Often
Sometimes
Rarely
Never
What's your inner narrative about your ability to stick to things?
Have you ever felt "addicted" to certain foods?
Yes
No
When motivation runs out, what happens to your habits?
What would change if food wasn't a daily mental battle?
How confident are you that you can change long-term? (1-10)
What patterns do you notice repeating, diet after diet?
Do you tend to be hard on yourself? (1-10)
What does "being kind to yourself" look like for you?
Anything else about your mindset or emotional relationship with food?
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Section 7: Fuel It — Nutrition Reality
Walk us through a typical day of eating
How many meals/snacks do you eat per day?
When are you hungriest?
Morning
Midday
Afternoon
Evening
Late night
Do you currently track your food?
Yes consistently
Sometimes
Tried it before
Never
If you've tracked, what app did you use?
Are you open to tracking for a few weeks?
Yes
Maybe
I'd rather not
How much protein do you think you eat daily?
Lots/I prioritize it
A moderate amount
Not much
No idea
How many times a week do you eat out or get takeout?
How many meals a week do you NOT prepare yourself?
What liquid calories do you drink?
Coffee with cream/sugar
Alcohol
Soda
Juice
Smoothies/shakes
Energy drinks
Just water/black coffee
Other
Other
How many alcoholic drinks per week?
What protein sources do you like?
Chicken/turkey
Lean beef
Pork
Fish/seafood
Eggs
Greek yogurt
Cottage cheese
Protein powder
Tofu/plant
Other
Other
What vegetables and fruits do you enjoy?
Leafy greens
Broccoli/cauliflower
Peppers/onions
Berries
Apples/pears
Melons
Bananas
Carrots
Cucumber/celery
Other
Other
What carb sources do you like?
Rice
Potatoes/sweet potatoes
Oats
Pasta
Bread
Beans/lentils
Tortillas
Quinoa
Other
What healthy fats do you like?
Avocado
Nuts/nut butter
Olive oil
Cheese
Whole eggs
Seeds
Other
Other
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Section 8: Live It — Lifestyle, Movement & Your Training
What type of workouts are you currently doing?
OrangeTheory
F45
CrossFit
Boutique HIIT
Pilates/barre
Bootcamp
Running
Hiking
Spin/cycling
Weightlifting on my own
Yoga
Walking
Swimming
Group fitness classes
Other
Other
Be specific — what studio, program, or modality do you train with?
How many days per week do you work out?
How long have you been training consistently?
Less than 6 months
6-12 months
1-3 years
3-5 years
5+ years
Decades
How would you rate the intensity of your workouts?
Very high
High
Moderate
Light
How long is a typical workout?
Under 30 min
30-45 min
45-60 min
Over 60 min
What time of day do you usually train?
Early morning
Morning
Midday
Afternoon
Evening
Do you do any strength training specifically?
Yes regularly
Sometimes
Rarely
Never
How many days per week of dedicated strength training?
Do you feel your workouts are getting you results?
Yes
Used to but not anymore
Never really
Not sure
What do you love about how you train?
What injuries, limitations, or aches do you work around?
Is there anything you want to improve or emphasize physically?
Any foods you absolutely won't eat?
Any food allergies or intolerances?
Do you cook, or prefer quick/prepared foods?
Love to cook
Cook when I have to
Prefer prepared/easy
Mix of both
Who prepares meals in your household?
Will your household eat healthier with you?
Yes they're on board
Somewhat
No it's just me
I live alone
Do you do any meal prep or planning?
Yes regularly
Sometimes
Never
What does your pantry/fridge usually look like?
What are your biggest snack weaknesses?
When you binge, what do you reach for and how much?
How much water do you drink daily?
What's the hardest part about eating well for you?
Outside of workouts, how active is your daily life?
Very active
Moderately
Mostly sedentary
Desk job all day
How many steps do you average daily, if you know?
What non-workout movement do you enjoy?
Walking
Hiking
Gardening
Dancing
Playing with kids/grandkids
Sports
Biking
Swimming
Other
Other
What time do you typically wake up?
Is your wake time consistent, including weekends?
Yes
No
What time do you get in bed?
What time do you actually fall asleep?
Do you wake up during the night?
Often
Sometimes
Rarely
How much screen/social media time per day?
Under 1 hr
1-2 hrs
2-4 hrs
4+ hrs
Describe your typical daily schedule — work, family, life
What's your occupation?
How would you describe your work stress? (1-10)
What activities bring you joy that you don't do enough of?
What's draining your energy most right now?
What does your support system look like?
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Section 9: Readiness & What You Want Most
How much time per week can you realistically commit?
Under 2 hrs
2-4 hrs
4-6 hrs
As much as it takes
What's the #1 obstacle most likely to get in your way?
If you could wave a wand and fix ONE thing first, what would it be?
How much support are you looking for right now?
Just the community and resources for now
Structured guidance and a clear plan
Hands-on coaching and accountability
Full clinical 1-on-1 partnership with lab work and personalized protocols
Is there anything you've never told a coach or doctor that you want me to know?
Anything else you'd like to share before I build your report?
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