About You
How do you identify?
Non-binary / prefer not to say
About You
What's your age range?
How You Feel
How would you describe your energy levels most days?
Generally good — I feel energized and capable
Inconsistent — some good days, some not
Often low — tired even after a full night's sleep
I crash mid-afternoon or rely on caffeine to get through the day
Sleep & Energy
How is your sleep?
Solid — I fall asleep easily and wake rested
Okay — not great, not terrible
Poor — I struggle to fall or stay asleep
I sleep but never feel rested
Gut & Digestion
How would you describe your digestion and relationship with food?
Generally fine — no major issues
I experience bloating, gas, or discomfort regularly
I have food sensitivities I haven't fully figured out
I've been told I have IBS — but feel like there's more to it
My weight or metabolism feels off regardless of how I eat
Hormones & Cycle Health
Are you experiencing any hormonal concerns?
Irregular cycles, PMS, or cycle-related symptoms
Fertility concerns or actively trying to conceive
Perimenopause or menopause-related changes
Thyroid, adrenal, or metabolic concerns
Low libido or general hormonal imbalance
Stress & Mental Health
How would you describe your stress and mental health right now?
Manageable — I feel generally balanced
Elevated — more stressed than I'd like to be
I deal with anxiety, worry, or racing thoughts regularly
Burnt out — depleted and running on empty
Low mood, depression, or feeling disconnected
Stress & Mental Health
How does stress tend to show up in your body?
Select all that apply
Tension, headaches, or jaw clenching
Gut issues that get worse under stress
Sleep disturbances when stressed
Skin flare-ups or inflammation
I don't really notice stress in my body
Lifestyle
How would you describe your current relationship with food?
Pretty healthy — I eat well most of the time
Confused — I've tried a lot of approaches and nothing sticks
Complicated — emotional eating or a tricky relationship with food
Food feels fine but I still feel inflamed or unwell
I want to optimize — not fix a problem, just do better
Lifestyle
How active are you?
Very active — training regularly and hard
Moderately active — moving most days
Lightly active — walks, occasional workouts
Mostly sedentary — I know I need to move more
What You've Tried
Have you worked with any wellness practitioners before?
Select all that apply
Functional or integrative medicine provider
Nutritionist or dietitian
Therapist or mental health provider
Recovery or bodywork (massage, sauna, etc.)
None — I'm starting fresh
Your Goals
What are you most hoping to address or improve?
Select your top two
Energy, fatigue, or brain fog
Weight, metabolism, or body composition
Stress, anxiety, or mental health
Digestion, gut health, or inflammation
Hormonal balance or reproductive health
Recovery, longevity, or physical optimization
I just want to understand my body better
Your Goals
What does success look like for you in the next 6 months?
I feel genuinely well — energized, clear-headed, and consistent
I have real answers about what's going on in my body
I've made meaningful progress with weight or body composition
I feel calmer, more balanced, and less reactive to stress
I have a clearer path forward on my reproductive health journey
I'm performing and recovering better than I am now