How often do you feel bloated, gassy, or uncomfortable after meals? *

Rarely or never

A few times a week

Almost daily

Every meal feels uncomfortable

Describe your energy throughout the day *

Pretty steady

Afternoon crash but recover

Always tired even after sleep

Big swings (wired then tired)

How would you rate your stress levels lately?

Manageable

Moderate but noticeable

High most days

Extreme, constant stress

Do you notice cycle irregularity, PMS, or hormone-related struggles?

No issues

Mild but noticeable

Significant PMS, irregular cycles, mood swings

Ongoing PCOS, thyroid, or fertility struggles

Which of these do you struggle with the most? *

Digestive discomfort

Cravings, stubborn weight, sugar crashe

Fatigue, poor sleep, anxiety

Mood swings, skin issues, irregular cycles

Brain fog, brittle nails, tingling, weakness

How often do you crave sugar, carbs, or caffeine just to get through the day? *

Rarely

A few times a week

Daily cravings

Multiple times a day, can’t function without it

Do you currently experience skin issues (acne, eczema, rashes)? *

Occasionally

Frequent breakouts/rashes

Chronic or cystic issues

What’s your top wellness goal right now? *

Better digestion

More energy / better sleep

Balanced hormones / easier cycles

Weight loss or blood sugar balance

Clearer thinking, stronger immunity

First Name

Last Name

Email *

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