Welcome

Name* This field is required.Let’s get going!

First Name

Last Name

Email* This field is required.Your results will be sent via email!

example@example.com

Date of birth:* This field is required.

Date

Height and Weight* This field is required.

Height

Weight

How many hours of sleep do you get on average?* This field is required.

Do you wake up feeling rested?* This field is required.

YESNO

Do you experience difficulty falling or staying asleep?* This field is required.

YESNO

How would you describe your daily energy levels?* This field is required.

What types of exercise do you do? * This field is required.Check all that apply

Do you experience exercise-induced fatigue or difficulty recovering from workouts?* This field is required.

YESNO

How would you describe your stress levels?* This field is required.

What are your primary sources of stress?* This field is required.Check all that apply

Do you practice any stress management techniques?* This field is required.(e.g., meditation, breathwork, journaling, yoga, therapy) Please list them below, if so.

How would you describe your eating habits?* This field is required.

Balanced and nutrient-dense

High-carb, low-fat

Low-carb, high-fat (e.g., keto)

High protein

Vegetarian or Vegan

Inconsistent or emotional eating

How often do you consume processed or fast food?* This field is required.

Rarely or never

1-2 times per week

3-4 times per week

Daily

Do you experience cravings?* This field is required.Check all that apply

Sugar

Salt

Caffeine

Carbs

Fatty foods

Do you consume alcohol* This field is required.

Occasionally (1-2 drinks a month)

Regularly (1-2 drinks per week)

Frequently (3+ drinks per week)

Do you consume caffeine* This field is required.

1 cup per day

2-3 cups per day

4+ cups per day

Do you take any supplements or vitamins?* This field is required.Please list them below

Do you have any dietary restrictions, food sensitivities, or allergies?* This field is required.If Yes please specify (Click "Next" if No)

Which of the following symptoms are you currently experiencing?* This field is required.Check all that apply

Fatigue

Weight gain, especially around the belly

Difficulty losing weight

Bloating or water retention

Brain fog or memory issues

Low libido

Mood swings or irritability

Anxiety or depression

Hair thinning or hair loss

Acne or skin issues

Breast tenderness

Hot flashes or night sweats

Cold hands and feet

Muscle or joint pain

Headaches or migraines

When did these symtoms first begin?* This field is required.

Have you noticed any patterns in your symptoms?* This field is required.(e.g., around your period, during ovulation, under stress)

Do you have a menstrual cycle?* This field is required.

Yes

No (e.g., menopause, hysterectomy)

How long is your typical cycle?* This field is required.

21-25 days

26-30 days

31+ days

Irregular

Do you experience any of the following menstrual symptoms?* This field is required.Check all that apply

Heavy bleeding

Painful cramps

Spotting between periods

Clotting

PMS (mood swings, cravings, bloating)

None

Have you experienced any reproductive health issues?* This field is required.If Yes, please specify. (If no, please click "next")

Have you experienced perimenopause or menopause symptoms?* This field is required.

Yes

Unsure

Do you have any diagnosed medical conditions?* This field is required.If Yes, please specify. (If no, please click "next")

Are you currently taking any medications?* This field is required.If Yes, please specify. (If no, please click "next")

Do you have a family history of hormonal or metabolic issues?* This field is required.(e.g., thyroid disorders, diabetes, PCOS, breast cancer)

Is there anything else you’d like me to know about your health, goals, or symptoms?* This field is required.