Full Name
Email
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Phone
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1. Are you male or female?
Male
Female
Non-binary
Prefer not to say
Other
2. How would you describe your current energy levels?
I crash mid-afternoon daily
I wake up tired no matter how much I sleep
I have bursts of energy followed by burnout
I feel great most of the time
Other
3. How are you feeling mentally and emotionally?
I feel irritable or anxious for no reason
I struggle with focus or feel foggy often
I’m fine most days, but have mood swings
Mentally sharp and emotionally balanced
Other
4. Have you noticed any changes in your body composition?
I’m gaining weight without changing my diet
I’ve lost muscle and gained fat
My body shape has changed and I don’t know why
No noticeable changes
Other
5. How would you describe your libido?
It’s completely gone
Lower than it used to be
Comes and goes
Healthy and consistent
Other