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First Name
Last Name
Email
Age Range
45-54
54-65
65+
Phone
Please check the box that applies:
Peri-Menopause (still have periods but they are irregular)
Menopause (haven't had a period in 12 months)
Post menopausal (2 years since period stopped)
Check the box that best describes your current fitness level?
Highly Active: intense exercise 3 or more times per week
Moderately Active: walking, cleaning and/or gardening
Very little activity: sedentary job, drive most everywhere
Dietary preferences
Paleo
Ketogenic
AIP [Autoimmune Protocol]
Whole 30
Vegan
Vegetarian
Macrobiotic
Raw Foods
Flexitarian
Mediteranean
DASH [Dietary approaches to stop hypertension]
GAPS (Gut and Psychology syndrome]
Other
Describe in the field below what "Other" dietary preference you follow:
Check the priorities that are most important to you:
Weight Loss
Strength and Endurance
Hormone Balance
Decrease Stress and Anxiety
Improve Sleep
Select All
Name
This field is for validation purposes and should be left unchanged.
