Health Questionnaire

Low energy / fatigue Weight gain / difficulty losing weight Low libido Erectile dysfunction Mood swings / irritability Anxiety / nervousness Depression / low mood Brain fog / difficulty concentrating Insomnia / poor sleep Night sweats / hot flashes Hair loss Joint pain / stiffness Gynecomastia (male breast tissue) Acne / skin issues Loss of muscle mass Increased body fat Fluid retention / bloating Digestive issues Heart palpitations Headaches

Hypothyroidism Hashimoto thyroiditis Type 2 diabetes High blood pressure Heart disease Depression / anxiety disorder Sleep apnea PCOS Endometriosis Low testosterone (diagnosed) Adrenal fatigue / burnout Gut dysbiosis / SIBO None of the above

Increase energy Lose body fat Build muscle Improve libido / sexual function Better mood / mental clarity Improve sleep Reduce stress Balance hormones