Section 1: The Basics

Full Name *

Phone (Optional for SMS Reminders)

Email *

Instagram or FB Handle (So I can contact you swiftly))

Country of Residence (This helps me tailor your product recommendations and shipping options!) *

What are you looking for support with? *

Fitness & nutrition coaching

Hormone Wellness Supplements & Support

Both fitness/nutrition and Hormone Support

I'm just browsing and gathering information right now

Current Life Stage: *

Perimenopause

Post-Menopause

I Have No Idea! Help!

Section 2: The "Messengers" (Symptoms)

What are your Top frustrations right now? (Check all that apply) *

On a scale of 1-10, how much is this affecting your daily confidence? *

Section 3: The "Terrain" (Current Routine)

Are you currently on BHRT or any hormone medications? (e.g., Estrogen, Testosterone, Progesterone, Thyroid meds) Please list ALL or write NONE if not applicable *

Are you using any GLP-1 support? (e.g., Ozempic, Wegovy, Mounjaro) List which one or NONE or Used to Be *

What supplements are you currently taking daily? (List everything (Brands etc) —let's see where we can simplify and save you money!) *

Do you have any known allergies or dietary restrictions? (e.g., Gluten-free, Dairy-free, Vegan, Medication etc...) *

Section 4: The Goal

If we could fix ONE thing in the next 90 days, what would it be?

Which best describes you right now? *

I'm ready to get started and would like help choosing my next step.

I'm interested and would like to learn more before deciding.

- I'm just exploring for now.

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