Do you use any of the following forms of hormonal contraception?

Why have you chosen this method of birth control?

Have you ever suffered from hypertension or high blood pressure?

When it comes to vitamins and supplements, you are:

Do you currently take any supplements?

Where do you currently purchase your supplements?
Select all that apply

When it comes to traditional, Eastern Medicinal practices,like Ayurveda or TCM, you are:

In an average day, how often do you eat a portion of fruit or veggies?

In an average week, how often do you eat fish or seafood?

In an average week, how often do you eat red meat?

How would you describe your sugar habits?

How would you describe your overall diet?
Select all that apply

Are you allergic/choose not to consume any of the following?
Select all that apply

How many alcoholic beverages do you typically consume in a week ?
No judgement, we love a good drink too 😉 'One beverage = 1 shot/1 (250ml) glass'

Do you, or have you, regularly smoke(d)/vape(d)?

How often do you exercise?

Are you looking to support any of the following issues?

Do you know what type of PCOS you currently suffer from?

Do you know what type of thyroid issues you suffer from?

Which life moment are you looking to support?
(Select one)

Describe your menstrual cycle

Do you suffer from intense mood swings before or during your period?

Do you suffer from chronic headaches before or during your period?

How severe is your menstrual cramping?

What is the colour of your menstrual blood?

Is your flow....

How often do you menstruate?

Are you looking to get pregnant in the next 12 months?

Have you had trouble concieving in the past?

Describe your menstrual cycle

Are you currently engaging in any of the following for your prenatal health
(select all that apply):

What trimester of your pregnancy are you currently in?

Are you currently breastfeeding?

Have you or are you experiencing any symptoms associated with Post Partum Depression?

Have you or are you experiencing any post-partum hair loss?

Have you or do you suffer from hot flashes?

In general your mood is...
(select all that apply)

Have you or do you suffer from any of the following?
Select all that apply

Would you be interested in supporting any other health concerns?
(Choose up to 2 options)

Do you struggle with bloating?

In general, your bowel movements are...

Do you experience frequent burping after meals?

Do you experience frequent abdominal pain (before and after meals)?

How many times a year would you estimate you get sick (common cold, cough, fever, etc...)

Have you tested positive for Covid-19?

For your sleep, what do you struggle with the most?

You are most fatigued...

How would you describe your sex drive?

Do you often have spontaneous sex?

Do you experience pain during sex?

How would you describe your orgasms?

Are you concerned about vaginal dryness?

Do you struggle with excess facial hair

Do you suffer from hair loss?

Is your hair thinning over time?

Do you suffer from any mood conditions?
Select all that may apply

In general your mood is...
Select all that may apply!

Tell us about your skin...

Not including acne, do you experience any skin conditions?
Select all that apply

Have you taken any prescription medications to address skin issues
(ie. Roaccutane, Spironolactone, Birth Control, etc...)

How does stress feel in your body?

You feel most fatigued...

You feel most fatigued...

When you lack energy you...
(Select all that apply)