This short self-check helps you notice patterns around energy, hunger, stress, and stability. It’s not a diagnosis, just clarity.

First Name *

Last Name *

Email *

What is your age? *

Choose as many as apply *

Food Cravings

Weight Gain/Stubborn Weight/Obesity

Fatigue/Energy Crashes

Bloating

Hormonal Imbalance

Hair Loss

Sinus Issues

Mood Swings

Thyroid Issues

Frequent Illness

Inflammation

Anxiety/Depression

Digestive Issues/IBS

Joint Pain

Sleep Issues

Brain Fog

Headaches

Waist Size > 35"

High Cholesterol or Blood Pressure

Arthritis

Insulin Resistance/Pre-Diabetes

Non Alcohol Fatty Liver Disease

Chronic Pain/Autoimmune Disease

None of the above

Do you experience an afternoon energy crash (usually between 2–4 pm)? *

Rarely / Never

Sometimes

Often

Almost always

Do you wake up between 2 and 3 AM most nights, even if it's just to use the bathroom? *

Rarely / Never

Sometimes

Often

Almost always

Do you wake up feeling unrefreshed, even after what should be enough sleep? *

Rarely / Never

Sometimes

Often

Almost always

If meals are delayed, do you feel shaky, irritable, anxious, or foggy? *

Rarely / Never

Sometimes

Often

Almost always

Do you find yourself looking for or craving quick snacks like chips or cookies in the afternoon? *

Rarely / Never

Sometimes

Often

Almost always

Do you feel like you have to be very careful with food in order to feel okay or stay “on track”? *

Rarely / Never

Sometimes

Often

Almost always

Does stress seem to immediately affect your energy, digestion, sleep, or appetite? *

Rarely / Never

Sometimes

Often

Almost always

Do flare-ups, inflammation, or “off days” feel unpredictable or hard to explain? *

Rarely / Never

Sometimes

Often

Almost always

Do small disruptions (poor sleep, a missed meal, a busy day) throw your whole system off? *

Rarely / Never

Sometimes

Often

Almost always

Which best describes how you feel right now? *

I want clarity before making another change

I’m doing “most things right” but not seeing results

I feel unstable and don’t know why

I feel exhausted and frustrated

On a scale of 1-10 how ready are you to learn something new and change your life and health for the better *