Changing is never easy but you’ve taken the first step.

Complete my Hormone Balance Evaluator below and I will recommend a biodentical hormone plan that is easy to put into practice, is totally natural and supports your entire life.

Every woman experiences the effects of hormone imbalance in a different way. Restoring it naturally takes a plan that addresses the symptoms you are experiencing at your particular stage in life. After treating over 10,000 women I created this hormone balance evaluation tool to deliver an easy to follow custom plan. Let’s get started...

Name and E-mail

First name

E-mail address

Bio Data

Age
Please choose 20-39 40-59 60+

Height
Please choose 4´ 5" – 4´ 8" 4´ 9" – 4´ 10" 4´ 11" – 5´ 0" 5´ 1" – 5´ 2" 5´ 2½" – 5´ 3½" 5´ 4" – 5´ 5" 5´ 6" – 5´ 7" 5´ 7½" – 5´ 8½" 5´ 9" – 5´ 9½" 5´ 10" – 5´ 11" 5´ 11½" – 6´ 0"

Weight (lbs)
Please choose Please select height 10+ lbs below ideal 10+ lbs above ideal

Are you currently experiencing...

Fatigue
Yes No

Hot Flashes / Night Sweats
Yes No

Insomnia / Sleep Disturbances
Yes No

Weight Gain
Yes No

Itchy Skin / Acne
Yes No

Frequent Headaches / Migraines
Yes No

Bloating
Yes No

Breast Tenderness
Yes No

Anxiety
Yes No

Palpitations
Yes No

Mood Swings / Irritability
Yes No

Decreased Patience and Tolerance
Yes No

Loss of Sex Drive
Yes No

Painful Sex / Vaginal Dryness
Yes No

Recurrent Urinary Tract Infections
Yes No

Recurrent Yeast Infections
Yes No

Change in Hair Quality / Hair Loss
Yes No

Joint Pains
Yes No

High Blood Pressure
Yes No

Irregular Periods
Yes No

Severe Menstrual Cramps
Yes No

Heavy Menstrual Bleeding
Yes No

Constipation / Change in Bowel Habits
Yes No

Lifestyle

Are you stressed to the hilt?
Yes No

Do you like your job or school work?
Yes No

Do you smoke tobacco?
Yes No

Do you take recreational drugs?
Yes No

Do you use products that contain artificial sweeteners?
Yes No

Are you in a rewarding sexual relationship?
Yes No

Do you eat a well balanced diet more often than not consisting of whole unprocessed foods?
Yes No

Do you drink beverages which contain caffeine such as coffee or soda?
Yes No

Do you exercise a minimum of 3 times a week? walking/running/weight training/yoga/aerobics
Yes No

Do you drink alcoholic beverages?
Yes No

Menstrual Status

Do you still have your period?
Yes No

Medical History

Surgical Menopause- Hysterectomy, Oophorectomy
Yes No

Medical Menopause- Fertility Drugs, Chemotherapy, Radiation Therapy
Yes No

Medications: Birth Control Pills, Synthetic HRT, Bioidentical hormones, Antidepressants
Yes No

Family History: Cancer, Heart disease on mother’s side, on father’s side
Yes No

Medical History: Heart Disease, Cancer, Arthritis, Collagen Vascular Disease, Thyroid ( high/ low), Adrenal metabolic syndrome, Blood Clotting problems
Yes No

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