Welcome to your Wellness Survey

A quick self-check for better balance.
Answer a few questions to see if a Functional Wellness Consultation is the right next step.

Takes ~2–3 minutes • Results are informational

Please check all symptoms you experience regularly (weekly or more often).
Each check = 1 point.

1. Digestion & Gut Health

Constipation

Bloating or gas

Loose stools or urgency

Food sensitivities or reflux

Please check all symptoms you experience regularly (weekly or more often).
Each check = 1 point.

2. Sleep & Energy

Trouble falling asleep

Waking during the night

Feeling unrested in the morning

Daytime fatigue or low energy

Please check all symptoms you experience regularly (weekly or more often).
Each check = 1 point.

3. Mood & Brain Health

Brain fog or difficulty concentrating

Anxiety or irritability

Low mood

Feeling “wired but tired” at night

Please check all symptoms you experience regularly (weekly or more often).
Each check = 1 point.

4. Hormones & Sexual Health

Low sex drive

PMS, cycle symptoms, or irregular cycles (if applicable)

Hot flashes or night sweats

Hair thinning or dry eyes and/or mouth

Please check all symptoms you experience regularly (weekly or more often).
Each check = 1 point.

5. Metabolism & Weight

Stubborn weight gain (especially around the midsection)

Difficulty losing weight despite healthy habits

Muscle loss

Sugar cravings or blood sugar swings

6. Are you interested in learning more about our Functional Wellness services?(Required)

Yes, I’d love to schedule my complimentary consultation

Maybe, I’d like more information first

Not right now

0–5 points: You may just need small lifestyle adjustments — but we can still help optimize your health.

6–11 points: These symptoms suggest possible imbalances in hormones, gut health, or metabolism — a Functional Wellness Consultation is recommended.

11+ points: Your symptoms strongly suggest underlying root causes that can benefit from a comprehensive Functional Wellness plan.

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Wellness Symptoms

WELLNESS SURVEY

Welcome to your Wellness Survey