1. How would you describe your energy levels throughout the day? *

Always tired, struggling with fatigue daily

Low energy often, need caffeine or sugar for a boost

Mostly stable, but some dips in the afternoon

Consistently high energy, no crashes

2. How do you feel after eating a meal? *

Still hungry, craving sugar or carbs immediately after

Hungry again within 1-2 hours, occasional cravings

Full but sometimes sluggish

Satisfied and energized, no cravings

3. How often do you experience brain fog or difficulty concentrating? *

Daily, it’s hard to focus and think clearly

Often, especially in the afternoon

Occasionally, especially after meals

Never, my mind is sharp

4. How would you describe your body composition? *

Struggling with significant weight gain

A little overweight, carrying extra fat mostly in the midsection

Healthy weight but could tone up

Lean and muscular, no excess fat

5. How often do you experience cravings for sugar or carbs? *

Constantly, I feel addicted to sugar

Frequently, I snack often

Occasionally, but I can manage them

Rarely, I feel satisfied with my meals

6. How often do you exercise or engage in physical activity? *

I don’t exercise at all

1 time per week or less

2-3 times per week

4+ times per week, mix of strength and cardio

7. How would you describe your sleep quality? *

Terrible, I struggle with insomnia or waking up exhausted

Poor, I wake up multiple times or feel unrested

Decent, but I wake up once or twice

Great, I sleep 7-9 hours and wake up refreshed

8. Do you have a history of metabolic conditions (diabetes, pre-diabetes, insulin resistance, high blood pressure, high triglycerides, sleep apnea, PCOS, etc.)? *

Yes, I have been diagnosed with a metabolic disorder

Yes, I have some early signs (pre-diabetes, PCOS, etc.)

No, but my family has a history

No, never

9. How would you describe your stress levels? *

Overwhelming, I feel constantly anxious and burned out

High, I feel stressed often

Moderate, but I manage it with lifestyle habits

Low, I handle stress well

10. Do you wake up feeling rested and ready to start your day? *

Never, I struggle to get out of bed

Not really, I wake up groggy and sluggish

Mostly, but I need coffee to get going

Yes, I wake up energized every morning

First Name *

Last Name *

Email *

Phone *

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