Are you in Perimenopause or Menopause?
Yes
No
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How old are you?
35
35
65
Next
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How would you rate your energy levels?
35
Low
Meduim
High
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How would you rate your current libido?
0
1
2
3
4
5
Very low
Excellent
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Do you feel any of the following
Hot Flashes
Brain fog
Irritability
Mood Swings
Anxiety
Low libido
Difficulty staying asleep
Feelings of Depression
Difficulty Sleeping
Low Energy
weight gain
night sweats
itchy ears
joint pain
Cold Shoulders
Decreased Muscle Mass
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Full Name
Email
Do you know anyone who is in
perimenopause or
menopause?
Yes
No
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and the Ultimate Guide to Menopause
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Refer them to
book a free call
with our Health Coach.
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