First Name *

Last Name *

Phone *

Email *

How would you describe your energy levels most days? *

Have you noticed changes in your weight over the past 6–12 months? *

My weight has stayed about the same

I’ve gained weight despite eating well

I struggle to lose weight no matter what I try

My weight fluctuates a lot

How is your sleep? *

I sleep well and wake up rested

I have trouble falling asleep

I wake up during the night

I wake up tired even after 7–8 hours

How would you describe your mood or mental clarity? *

I feel mentally sharp and emotionally balanced

I experience brain fog or trouble focusing

I feel irritable or moody more than usual

I feel anxious, low, or unmotivated

How is your libido or sexual wellness? *

No changes

Slight decrease

Significant decrease

This is a major concern for me

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Is Your Body Trying to Tell You Something?

Take this quick symptom check to see if hormone or metabolic imbalances

could be affecting your energy, weight, or mood.