What is your name?

Where do you want us to send your results?

What is your age?

What is your preferred measurement system?

What is your height?

Inches*

What is your current bodyweight?

What is your height?

What is your current bodyweight?

Which of the following best describes your menstrual cycle and symptoms?

How long has it been since your last menstrual period?

How much do menopause symptoms affect your daily life?

Are you currently taking or have you taken in the past any forms of menopausal hormone therapy (HRT)?

Brain fog (difficulty with memory, concentration, focus, executive function)

Hot flashes, sweating (episodes of sweating)

Heart discomfort (unusual awareness of heartbeat, heart skipping, heart racing, tightness)

Joint and muscular discomfort (pain in the joints, rheumatoid complaints, frozen shoulder)

Sleep problems (difficulty in falling asleep, difficulty in sleeping through the night, waking up early)

Digestive issues? (Bloating, constipation, diarrhea, gas)

Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings)

Irritability (feeling nervous, inner tension, feeling aggressive)

Anxiety (inner restlessness, feeling panicky)

Physical and mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness)

Sexual problems (change in sexual desire, sexual activity and/or sexual satisfaction)

Bladder problems (difficulty in urinating, increased need to urinate, bladder incontinence)

Dryness of the vagina (sensation of dryness or burning in the vagina, difficulty with sexual intercourse)

Changes in your skin (dryness, thinning) or hair (loss, thinning)

How long have you been following a 100% plant-based (vegan) diet?

What is your primary reason for following a vegan diet?

How do you ensure you’re getting enough of essential nutrients like protein, calcium, vitamin B12, iron, and omega-3 fatty acids?

Select all that apply.

Do you consume alcohol?

How many days per week do you engage in physical exercise for at least 30 minutes?

What is the main obstacle to getting more regular physical activity?

What types of physical activity do you typically engage in?

Select all that apply.

How many days per week do you spend over 60 minutes sitting and watching TV, Netflix, YouTube, or another video streaming platform?

On average, how many hours of sleep do you get per night?

How frequently do you have trouble falling asleep or staying asleep?

How frequently do you feel tired during the day?

How would you rate your average stress level over the past month?

What methods do you use to manage stress?

Select all that apply.

Do you have a support system of health-focused women to discuss wellness and menopause-related experiences?

Are you currently working with any healthcare professionals for menopause management?

Select all that apply.

Do you have any existing medical conditions?

Select all that apply.

Have you had any of the following tests in the past year?

Select all that apply.

What are your primary health goals?

Select all that apply.

What types of support or resources are you most interested in?

Select all that apply.

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