Comprehensive Energy & Metabolism Audit
Welcome! This assessment helps me understand what's happening in YOUR body so I can give you personalized, root-cause insights. It takes about 10-15 minutes to complete. Answer as honestly as you can—there are no "wrong" answers.
Personal Information
Name
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Email address
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Age
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Are you currently on HRT or BHRT? (Y/N)
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Current medications or supplements (list all, or write 'none')
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Perimenopause / Menopause / Postmenopause (choose one)
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What are your TOP THREE symptoms right now?
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Nervous System Stress Load
Rate each 0–5 (0 = never, 5 = daily)
I wake up already tired or tense.
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Please Select
0
1
2
3
4
5
I feel overwhelmed more easily than I used to.
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Please Select
0
1
2
3
4
5
Small things trigger irritability or frustration.
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Please Select
0
1
2
3
4
5
I experience afternoon energy crashes.
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Please Select
0
1
2
3
4
5
I get “tired but wired” at night.
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Please Select
0
1
2
3
4
5
It takes me a long time to wind down before bed.
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Please Select
0
1
2
3
4
5
I rely on caffeine to get through the day.
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Please Select
0
1
2
3
4
5
I often feel on edge, overstimulated, or “fried.”
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Please Select
0
1
2
3
4
5
My heart rate feels elevated even at rest.
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Please Select
0
1
2
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4
5
Hidden stress questions:
Do you feel responsible for everything/everyone?
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Yes
No
Are you constantly multitasking?
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Yes
No
Do you struggle to rest without feeling guilty?
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Yes
No
Metabolic Stress & Blood Sugar Patterns
Rate each 0–5 (0 = never, 5 = daily)
My weight increases even when I eat “clean.”
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Please Select
1
2
3
4
5
I skip meals or under-eat without meaning to.
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Please Select
1
2
3
4
5
I feel shaky, hangry, or irritable when hungry.
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Please Select
1
2
3
4
5
I get energy spikes followed by crashes.
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Please Select
1
2
3
4
5
I rely on carbs, caffeine, or snacking for energy.
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Please Select
1
2
3
4
5
I crash after meals or feel heavy/tired.
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Please Select
1
2
3
4
5
My cravings increase when stressed or tired.
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Please Select
1
2
3
4
5
I feel full for less than 2 hours after a meal.
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Please Select
1
2
3
4
5
Are you intentionally restricting calories?
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Do you track protein? If yes, how much do you eat per day?
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Hormone Symptom Patterns
Estrogen under stress (check all that apply):
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Bloating
Mood Swings
Heavy/unpredictable bleeding
Breast tenderness
Mid-cycle anxiety
Progesterone under stress: (check all that apply):
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Irritability
Anxiety
Sleep problems
Spotting
Short cycles
Cortisol under stress (check all that apply):
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Morning Dread
Belly Fat
Brain Fod
Cravings
Afternoon Crash
Feeling Wired
Feeling “flat” or unmotivated
Thyroid under stress (check all that apply):
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Weight gain
Cold hands/feet
Constipation
Dry skin/hair
Low energy
Slow metabolism
Sleep Quality
Rate each 0–5 (0 = never, 5 = often)
I fall asleep easily.
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Please Select
1
2
3
4
5
I stay asleep through the night.
*
Please Select
1
2
3
4
5
I wake up feeling rested.
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Please Select
1
2
3
4
5
I wake up during the night hot or anxious.
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Please Select
1
2
3
4
5
I wake up around 2–4 AM.
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Please Select
1
2
3
4
5
I need naps to get through the day.
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Please Select
1
2
3
4
5
Hidden Stressors Checklist
Check all that apply.
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Blood sugar instability
Poor sleep
Nutrient deficiencies
Digestive issues (bloat, gas, constipation, loose stools)
Chronic inflammation (aches, puffiness)
Over-exercising
High emotional load
Over-responsibility
High work stress
Environmental toxin exposure
Always rushing
Sensory overload
Life Load & Capacity
On a scale from 1–10, how overwhelmed do you feel most days?
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How much energy do you realistically have for change right now?
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What does a typical day look like?
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What is your biggest challenge in staying consistent?
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What is one thing you wish you understood about your body?
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Your Personal Goals
What do you most want to improve right now?
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What would “feeling like yourself again” look like?
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If I could help you fix ONE thing first, what would it be?
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Lifestyle Analysis
Daily rhythm & movement
How many hours do you typically sit each day?
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How often do you walk or move intentionally (0 = rarely, 5 = multiple times daily)?
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How often do you exercise to exhaustion? (0 = never, 5 = daily)
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Nutrition & hydration habits
How many meals do you eat each day?
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Do you eat breakfast within 1 hour of waking?
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How much water do you drink daily?
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How often do you rely on caffeine or snacks for energy? (0 = never, 5 = daily)
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Sleep & recovery rhythm
Average bedtime / wake time
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How consistent are your sleep hours (0 = chaotic, 5 = consistent)?
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How often do you feel rested in the morning? (0 = never, 5 = always)
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Environment & self-care
Screen time after 8 pm (Y/N)
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Average daily outdoor or sunlight exposure (minutes)
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How often do you feel rushed all day? (0 = never, 5 = always)
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Let's Go!
What do you hope to leave this consultation with?
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Is there anything else you would like me to know? What specific questions do you have for me?
*
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Energy & Metabolism Audit
Within 3-5 business days after this form is submitted, you will receive an email with your report and a link to schedule your 30-minute call to go over your results.
$
397.00
Quantity
1
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