Is your age between 35 to 55?
Yes
No
Are you experiencing cravings?
Yes
No
Are you experiencing mid-morning or afternoon energy crashes?
Yes
No
Are you experiencing interrupted sleep or trouble falling asleep?
Yes
No
Have you noticed more weight on your mid-section and/or buttocks?
Yes
No
Are you experiencing any of the following:
Brain fog
Memory loss
Overwhelm
Anxiety
Unmotivated
Sign of depression
Change in libido
List any known health conditions:
Thyroid condition
Insulin resistance
Autoimmune
Polycystic Ovarian Syndrome
Other (specify below)
Are you experiencing being hot during the night or day?
Yes
No
Are you still menstruating?
Yes
No
Other
Do you experience NOT feeling physically strong and/or joint pain?
Yes
No
Are you ready for change?
I'm ready, for more energy!
Almost
Not yet
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