Hormonal Imbalance Quiz Please answer the questions below to the best of your ability. Thank you! Name * First Name Last Name Email * Phone (###) ### #### Have you experienced changes in the frequency or intensity of hot flashes or night sweats? Are you currently dealing with mood swings, irritability, or changes in mood that seem unrelated to external factors? Have you noticed any changes in your sleep patterns, such as difficulty falling asleep or staying asleep? Are you experiencing changes in libido or sexual satisfaction? Have you noticed any changes in your skin, such as dryness, acne, or changes in complexion? Are you experiencing changes in weight, particularly around the abdomen? Have you noticed any changes in your hair, such as thinning or increased hair growth in certain areas? Are you experiencing headaches or migraines more frequently than before? Have you had any changes in your energy levels or overall fatigue? How would you describe your menstrual cycle in the past few months? (Regular, irregular, heavy, light) How many days does your period last? How frequently are you getting your period? What pharmaceuticals and supplements are you currently taking? Do you have any dietary restrictions? Have you had your hormone levels tested? Is there anything else I should know? Thank you!
