First Name
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Last Name
Email
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1. How often do you experience hot flashes?
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A) Rarely—I'm lucky!
B) A few times a week—I'm managing.
C) Daily—they seem to love visiting me.
D) All day long—I feel like a human furnace!
2. When it comes to sleep, how would you describe your nights?
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A) Peaceful—I sleep like a log.
B) Intermittent—I wake up once or twice.
C) Restless—I toss and turn all night.
D) Non-existent—I’m practically nocturnal!
3. Have you noticed any changes in your mood lately?
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A) Nope, I feel like myself most of the time.
B) Sometimes, I’m a bit more emotional than usual.
C) Frequently, I swing between moods like a rollercoaster.
D) Yes, it feels like my emotions have taken over.
4. How would you rate your energy levels throughout the day?
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A) High—I’m unstoppable!
B) Medium—some days are better than others.
C) Low—I could use a daily nap.
D) Very low—I feel drained most of the time.
5. When it comes to nutrition, which best describes your approach?
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A) I prioritize balanced meals and feel great.
B) I try to eat healthy but sometimes give in to cravings.
C) I’m too busy to plan meals and grab whatever is convenient.
D) I feel stuck—my usual foods don’t satisfy me anymore.
6. How do you currently manage stress and maintain a positive mindset?
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A) I have a great routine—meditation, exercise, or journaling.
B) I manage pretty well but could use more consistency.
C) I try, but my efforts often fall short.
D) I feel overwhelmed and don’t know where to start.
7. Have you made any changes to your lifestyle or habits since entering menopause?
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A) Yes, I’ve embraced a new, healthier routine.
B) A few changes, but there’s room for more.
C) I’ve tried, but nothing seems to stick.
D) Not really—I'm unsure where to begin.
8. Do you find it challenging to stay motivated with exercise and physical activity?
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A) Not at all—I love staying active.
B) Sometimes, especially when I’m tired.
C) Often, I struggle to find the energy.
D) Yes, I’ve lost my motivation completely.
9. How do you feel about your relationship with food during menopause?
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A) I have a great relationship—I know what works for me.
B) I’m figuring out what feels good and what doesn’t.
C) I often crave comfort foods or sugary snacks.
D) I feel lost—nothing seems to satisfy me anymore.
10. On a scale of 1-10, how ready are you to embrace new habits for a healthier menopause experience?
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A) 10—I’m all in!
B) 7-9—I’m open to changes.
C) 4-6—I’m curious but not fully committed yet.
D) 1-3—I need some motivation!