The 2-Minute Hormone Care Fit Assessment

1
What’s your age range?* This field is required.
Under 35
35–44
45–54
55–60
Over 60
2
Which state do you live in?* This field is required.
Florida
Another state
3
Which of these have you noticed in the past few months? (Select all that apply)* This field is required.
Lower energy
Low libido or reduced desire
Trouble sleeping or 3 a.m. wake-ups
Mood changes, irritability, or anxiety
Brain fog
Hot flashes or night sweats
Unexplained weight changes
None of these
4
How would you describe your menstrual cycles?* This field is required.
Regular
Becoming irregular
Stopped in the last 12 months
Stopped more than 12 months ago
Not applicable
5
How much are these symptoms affecting your daily life?* This field is required.
Not much
Somewhat
A lot
Significantly disrupting my life
6
Have you been told your labs or hormones are “normal” while you still feel off?* This field is required.
Yes
No
Not sure
7
Have you tried hormone therapy or other treatments before?* This field is required.
Never
Non-hormonal options
Previously or currently on HRT and want better care
Not sure
8
What do you most hope hormone care could help with? (Select up to 2)* This field is required.
Energy
Libido/intimacy
Sleep
Mood
Focus
Hot flashes
Feeling like myself
9
How ready are you to invest in a high-touch hormone program if you’re a good fit?* This field is required.
Ready now
Interested, want to learn more
Just researching
10
First name* This field is required.
11
Email* This field is required.
example@example.com
12
State* This field is required.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
13
I’d like Precision Hormone Care to email me my results and program information. I understand this is educational and not medical advice.* This field is required.
Should be Empty: