Discover Your Menopause Balance Score: Unlock Your Path to Hormonal Harmony
First Name
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Last Name
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Email
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Phone
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1. Which age group do you fall into?
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35-40
41-45
46-50
51-55
56-60
60+
How would you describe your energy levels throughout the day?
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Consistently high
Moderate with occasional dips
Low, especially in the afternoon
Extremely low, affecting daily activities
How often do you experience hot flashes or night sweats?
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Never
Occasionally (1-2 times a week)
Frequently (3-5 times a week)
Daily
Have you noticed any changes in your weight recently?
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No changes
Slight weight gain
Significant weight gain
Weight loss
How would you rate your sleep quality?
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Excellent, I sleep through the night
Good, with occasional disturbances
Fair, I often wake up during the night
Poor, I have difficulty falling and staying asleep
How often do you experience mood swings or irritability?
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Rarely
Occasionally
Frequently
Almost daily
Have you noticed any changes in your memory or focus?
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No changes
Slight forgetfulness
Noticeable difficulty concentrating
Significant memory lapses affecting daily life
How would you describe your stress levels?
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Generally low
Moderate
High
Overwhelming
Have you experienced any changes in your libido?
No changes
Slight decrease
Significant decrease
Complete loss of interest
Do you experience any joint pain or muscle aches?
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Rarely
Occasionally
Frequently
Daily