How is your energy level after 2pm? *

I feel consistent energy all day.

I often hit a dip but can push through with a small snack or brief distraction.

I crash hard and frequently need coffee, sugar, or a nap just to function until dinner.

How often do you fall asleep easily and stay asleep through the night? *

I sleep soundly, consistently get 7-9 hours, and wake up feeling rested most days

I occasionally wake up between 2-4 AM, or I take a while to fall asleep a few nights a week.

I struggle to fall or stay asleep most nights, and I feel tired and unrefreshed when I wake up

How are your stress levels and general mood stability? *

I handle stress well and generally feel stable, calm, and able to manage my tasks.

I feel easily irritated, anxious, or overwhelmed right before my period, but generally fine otherwise.

I feel anxious, irritable, or overwhelmed by stress regularly—I'm often not feeling like myself.

What describes your experience with weight management? *

My weight is stable, and I feel comfortable and strong in my body and clothes.

I’ve noticed slow, creeping weight gain (especially around my middle) that is now very hard to shift.

I've gained significant weight that simply won't budge, despite diet and exercise efforts.

How do you describe your menstrual cycle and related physical symptoms? *

My period is regular, with minimal flow and minor (if any) PMS symptoms.

My cycle is getting shorter or heavier, and/or my PMS (e.g., breast tenderness, bloating) is noticeably worse.

My periods are very irregular/infrequent, or I experience common signs of perimenopause like night sweats/hot flashes.

How clear is your mental focus and memory? *

I have consistently clear focus and rarely struggle to find words or concentrate.

I get mild "brain fog" or occasional memory lapses, especially during high-stress times or when tired.

Brain fog is a daily struggle—I have poor focus, difficulty recalling words, and low mental energy.

Which age range best describes you? *

21-29

30-35

36-42

43-49

50 -55

56+

Full Name *

Email *

Phone

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