Diagnostic Assessment

BODY PROFILE

What is your current age?

18–25

26–35

36–45

46+

BODY PROFILE

What is your height in cm?

BODY PROFILE

What is your weight in kg?

BODY PROFILE

What is your waist measurement in cm?

CYCLE HORMONE

How regular is your menstrual cycle?

Regular

Slightly irregular

Highly irregular

Absent periods

CYCLE HORMONE

Rate the severity of your PMS symptoms.

None

Mild

Moderate

Severe

CYCLE HORMONE

How would you describe your acne or skin oiliness?

None

Occasional

Frequent

Severe

CYCLE HORMONE

Do you experience unwanted facial hair or significant hair thinning?

None

Mild

Moderate

Severe

METABOLIC

How often do you feel fatigued after a meal?

Never

Occasionally

Often

Almost always

METABOLIC

How intense or frequent are your sugar cravings?

Rare

Occasional

Frequent

Constant

METABOLIC

Describe your current weight gain pattern.

No change

Slow gain

Rapid gain

Weight loss impossible

STRESS SLEEP

What is your average sleep duration?

7–9 hours

6–7 hours

5–6 hours

<5 hours

STRESS SLEEP

How would you rate your typical sleep quality?

Restful

Sometimes restless

Frequent waking

Very poor sleep

STRESS SLEEP

In general, how would you describe your current stress level?

Low

Moderate

High

Extreme

GUT HEALTH

How often do you experience bloating?

Rare

Occasional

Frequent

Daily

GUT HEALTH

Do you have other persistent digestion issues?

None

Mild discomfort

Frequent issues

Severe symptoms

LIFESTYLE

How many times per week do you engage in physical exercise?

4+ times/week

2–3 times/week

1 time/week

None

LIFESTYLE

Describe your screen exposure habits before sleep.

Rarely use screens

Occasional use

Frequent use

Daily late use

LIFESTYLE

How would you rate your overall diet quality?

Whole food based

Generally balanced

Includes processed foods

Highly processed foods

FERTILITY

Are you currently trying to conceive?

No

Planning

Actively trying

Trying >12 months

FERTILITY

Have you ever been diagnosed with or suspected to have PCOS?

No

Suspected

Diagnosed