FIIT BOSS MENOPAUSE BREAKTHROUGH™ SCORECARD
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Body Changes & Menopause Impact
Compared with 3-5 years ago, how much harder is it for you to maintain your weight or body composition?
*
Not harder
Slightly harder
Moderately harder
Much harder
Extremely harder
Have you noticed more fat accumulating around your waist or abdomen?
*
No
A little
Somewhat
A lot
Extremely
How much have menopause-related changes affected your energy, confidence, or quality of life?
*
Not at all
A little
Moderately
A lot
Extremely
How much do menopause-related changes interfere with your ability to exercise consistently?
*
Not at all
A little
Moderately
A lot
Extremely
Fitness & Muscle
Do you feel physically weaker than you did several years ago?
*
Yes
No
Not sure
How consistently are you currently doing structured resistance or strength training?
*
Consistently, 3 or more times per week
Sometimes, 1–2 times per week
Rarely
Never
How would you rate your current overall fitness and exercise capacity?
*
Very low
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very low, 10 is Excellent
How difficult is it for you to recover after exercise?
*
Very easy
1
2
3
4
5
6
7
8
9
Very difficult
10
1 is Very easy, 10 is Very difficult
Nutrition & Metabolic Fitness
How difficult is it for you to manage hunger or cravings?
*
Very easy
Somewhat easy
Moderate
Quite difficult
Very difficult
How often do you experience noticeable energy crashes or strong cravings during the day?
*
Never
Rarely
Sometimes
Often
Very often
How confident are you that your current eating pattern provides enough protein and supports your fitness goals?
*
Very confident
Somewhat confident
Neutral
Not very confident
Not at all confident
How consistent is your eating pattern overall?
*
Very consistent
Mostly consistent
Somewhat inconsistent
Very inconsistent
Have you repeatedly dieted or reduced calories without getting the result you expected?
*
No
Yes, once or twice
Yes, several times
Yes, many times
Sleep, Stress & Recovery
How would you rate your overall sleep quality?
*
Very poor
Poor
Fair
Good
Very good
How refreshed do you generally feel when you wake?
*
Not refreshed at all
Slightly refreshed
Moderately refreshed
Very refreshed
Extremely refreshed
How would you describe your typical stress level?
*
Very low
Low
Moderate
High
Very high
How often does stress interfere with your eating, exercise or recovery?
*
Never
Rarely
Sometimes
Often
Very often
Hot Flash & Night Sweat Profile
Are you currently experiencing hot flashes or night sweats?
*
Yes
No
How disruptive are your hot flashes or night sweats?
*
Not at all
Slightly
Moderately
Very
Extremely
How often do hot flashes or night sweats disturb your sleep?
*
Never
Rarely
Sometimes
Often
Almost every night
Do stressful situations appear to precede or worsen your hot flashes?
Yes
No
Not sure
Have you noticed personal triggers such as alcohol, caffeine, spicy foods, hot environments, or similar situations around your hot flashes?
Yes
No
Not sure
Medical Support & Program Routing
Have you discussed your menopause symptoms or changes with a qualified healthcare professional?
*
Yes
No
Not yet
Prefer not to say
Would you be interested in learning about menopause treatment options you could discuss with a qualified healthcare professional?
*
Yes
No
Maybe later
Your Breakthrough Goal
What is the biggest change you want over the next 90 days?
*
Lose body fat
Build strength and muscle
Reduce hot flashes and night sweats
Improve energy and stamina
Sleep better
Feel calmer and more in control
Other
Which statement best describes you right now?
*
I need a clear plan and accountability
I have tried things before but need better results
I am ready to be consistent and committed
I feel stuck and want expert guidance
I want to optimize my routine and results
Other
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