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Enter Your Age
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
AIP [Autoimmune Protocol]
DASH [Dietary approaches to stop hypertension]
GAPS (Gut and Psychology syndrome]
Describe in the field below what "Other" dietary preference you follow:
What are your top 3 health and fitness goals?
What have you tried in the past to achieve those goals?
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)
Please list your top 3 concerns in order of importance
List any menopause symptoms you are currently experiencing:
Preferred means of contact:
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