Menopause Check-in: Readiness & Symptom Snapshot

This short snapshot helps you reflect on your current menopause symptoms and where you are right now.

It allows me to understand your experience before we speak, so our Menopause Check-In can be focused, supportive, and genuinely useful.

Completing this snapshot is required before booking a free Menopause Check-In.

Your answers are private and will only be used to support you.

Full Name *

Email *

Phone *

What brings you here today? Please share a few words about what made you reach out now, your “why now” story. *

What best describes where you are right now? *

I’m starting to notice changes and want to understand what’s happening.

I am in menopause, curious to explore what support is available

Pool sleep / Waking Through the night *

Never

Sometimes

Often

Constantly

Mood swings / anxiety / low patience *

Never

Sometimes

Often

Constantly

Night sweats / temperature changes *

Never

Sometimes

Often

Constantly

Weight changes or bloating

Never

Sometimes

Often

Constantly

Low libido or vaginal dryness *

Never

Sometimes

Often

Constantly

Brain fog or forgetfulness *

Never

Sometimes

Often

Constantly

Energy dips / afternoon crashes *

Never

Sometimes

Often

Constantly

Low motivation or joy *

Never

Sometimes

Often

Constantly

How would you describe your current lifestyle? *

I’m running on empty most days

I manage okay, but I feel drained

I’m doing well, but want to optimise my health

How ready do you feel to invest in your health right now? *

I’m curious and exploring options

I’m ready to make some changes

What type of support do you feel would suit you best? *

Group reset or challenge (accountability + connection)

Personalised consultation (testing + roadmap)

Ongoing support and coaching

Have you worked with a holistic or Traditional Chinese Medicine (TCM) practitioner before?

Yes

Not sure

Thank you for completing your Menopause Check-In: Readiness & Symptom Snapshot.

Thank you for taking the time to reflect on what’s been happening in your body and how you’ve been feeling. I know this stage of life can feel confusing and overwhelming at times.

I’ll personally review your responses and be in touch soon with clear, personalised guidance to help you move forward with confidence and support.

Warm wishes,
Jackie