Create Your Personalized Wellness Plan

Let's Create Your Wellness Plan

Personalized. Automated. Simple.
Our approach is grounded in deep expertise in identifying root causes, rebalancing the body from deficiencies and toxicities, and reducing stress on the body. We don’t treat disease—we support the underlying imbalances that influence overall wellness. By analyzing your symptoms, we can understand the priorities and severity of key systems in your body, allowing us to create a plan that targets what matters most.

Many clients notice improvements simply by following a simple, clear plan that aligns with their current state, supports their goals, and meets them where they are today—helping them move toward the healthier, more balanced version of themselves.
Client Intake

We’ll start with some basic information to personalize your Shine Wellness Plan. These details help us tailor recommendations based on your age, sex and wellness goals. Your information is kept private and used only to create your customized plan.
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Birth Year*
Sex*

MaleFemale
State*
Height*
Weight*
BMI Calculation*
Let's look at your detox needs

We're going to check in on your energy, digestion and mental clarity to see if your body might benefit from a functional medicine detox.
How would you rate your fatigue?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your bloating or digestive discomfort?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your brain fog?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Have you completed a functional medicine detox in the last 90 days?*

YesNo
Average Detox Symptom Rating
Average Detox + Toxin Rating
Detox Protocol Recommendation
Let's look at your gut health

Your gut plays a key role in digestion, nutrient absorption, and overall wellness. Answer the questions below so we can identify areas that may benefit from support.
How would you rate your heartburn or acid reflux?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your constipation?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your diarrhea or loose stools?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Average Gut Health Symptom Rating
Let's look at your skin health

Healthy skin can be an indicator of your internal balance. Let’s see how your skin has been feeling lately so we can determine if targeted support might help.
How would you rate your acne?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your eczema or rashes?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your dryness or flakiness?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your fine lines or premature wrinkles?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Average Skin Health Symptom Rating
Key lifestyle factors: sleep + stress

The way you sleep and manage stress has a powerful impact on your overall wellbeing. Let’s take a closer look at your rest and resilience to see if extra support could help bring more balance.
Do you have trouble falling or staying asleep?

Yes - MildYes - SevereNo
Do you feel anxious during the day?

Yes - MildYes - SevereNo
Which option most describes your overall energy?

Balanced and calmCan’t stop, won’t stopTired but wiredCompletely burnt out
How often do you practice mindfulness, meditation, or stress-reduction?

NeverOccasionallyA few times a weekDaily
How often do you spend time outdoors or in nature?

NeverOccasionallyA few times a weekDaily
Average Sleep + Stress Rating
Energy Protocol Recommendation
EA Spacer 1



Anxiety Protocol Recommendation
Energy + Anxiety Protocol Combined
E A Combined
ES Spacer 2
Sleep Protocol Recommendation
Energy + Anxiety + Sleep Protocol Combined
Sleep + Stress Plan
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Sleep + Stress Summary
Sleep + Stress Final Output
Checking in on age-related changes

The way your body and mind adapt with age can affect everything from memory to mobility. Let’s explore how you’ve been feeling lately so we can see where added support may help you stay strong, sharp and resilient.
Do you experience lapses in memory?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Do you experience difficulty concentrating?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Do you experience joint stiffness, aches or reduced mobility?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Average Age Health Symptom Rating
Understanding your toxin burden

Your body is designed to handle toxins, but just like a rain barrel, there’s a limit to how much it can hold. When that barrel starts to overflow, you may begin to notice symptoms and imbalances. Everyday products, food, water, or even hobbies can add to your toxin load. In this section, we’ll get a sense of where your exposures may be coming from. Later, we’ll share a short video that explains the rain barrel effect and how lowering your load can free up your body to function at its best.
How often are you exposed to toxins in your personal care products? *

NeverOccasionallyA few times a weekDaily
How often are you exposed to toxins in your home products?*

NeverOccasionallyA few times a weekDaily
How often are you exposed to toxins in your food and water? *

NeverOccasionallyA few times a weekDaily
How often are you exposed to toxins in your work or hobbies? *

NeverOccasionallyA few times a weekDaily
Average Toxin Exposure Rating
Hey girl! How are your hormones doing?

Your hormones act like messengers that keep your body in balance, supporting energy, mood, metabolism, sleep and reproduction. But when those signals get disrupted, it’s like static on the line, and you may start to notice symptoms that affect your daily life. Just as with toxins and the rain barrel effect, your hormone system can only compensate for so long before imbalances begin to spill over. In this section, we’ll get a sense of how your sex hormones and thyroid hormones may be showing up in your body. Later, we’ll share resources on how restoring balance can help you feel clearer, stronger and more resilient.
Over the past month, how would you rate your premenstrual symptoms (cramps, bloating, mood swings, breast tenderness)?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Premenstrual Not 0
Over the past month, how predictable have your menstrual cycles been?*

Not Present / RegularMildly IrregularModerately IrregularSeverely Irregular
Female Predictable Not 0
Over the past month, how would you rate your period heaviness or spotting between periods?*

0 = None (Normal Flow)1 = Mild (Slightly Heavier)2 = Moderate (Much Heavier)3 = Severe (Flooding or Very Heavy)
Female Heaviness Not 0
Over the past month, how would you rate your mood swings or irritability?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Mood Not 0
How would you rate fatigue or low energy over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Fatigue Not 0
How would you rate hot flashes over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Hot Flash Not 0
How would you rate low libido / arousal over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Libido Not 0
How would you rate poor sleep quality over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Poor Sleep Not 0
How would you rate brain fog or difficulty concentrating over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Female Brain Fog Not 0
Over the past month, how would you rate the lightness or absence of your periods?*

0 = None (Normal Flow)1 = Mild (Slightly Lighter)2 = Moderate (Much Lighter)3 = Severe (Skipped or Almost Absent)
Female Lightness Not 0
Average Female Hormone Symptom Rating
Total Estrogen Dominance Symptoms
Total Low Estrogen Symptoms
Female Hormone Supplement Recommendation
Hey man! Let's do a health check

Your body runs on finely tuned systems, and hormones play a big role in keeping your strength, energy, focus, and drive where they should be. When those levels get out of balance, you might notice shifts in performance, mood, or recovery. In this section, we’ll take a closer look at some key areas that can signal whether your hormones could use extra support. Think of it as checking the gauges on your dashboard—simple insights that can help you keep everything running at its best.
How would you rate your low libido over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Low Libido Not 0
How would you rate your fatigue or low energy over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Fatigue Not 0
How would you rate muscle loss or decreased strength over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Strength Not 0
How would you rate mood changes or irritability over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Mood Not 0
How would you rate poor sleep or difficulty waking refreshed over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Poor Sleep Not 0
How would you rate difficulty maintaining erections over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Erections Not 0
How would you rate brain fog or difficulty concentrating over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Brain Fog Not 0
How would you rate hair thinning or early balding over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Hair Not 0
How would you rate stress or cortisol-related symptoms over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Male Stress Not 0
Male Hormone Symptoms Total Not 0
Average Male Hormone Symptom Rating
Male Hormone Supplement Recommendation
Check your thyroid health

Your thyroid plays a key role in regulating energy, metabolism, mood and temperature. By understanding how your thyroid may be affecting your body, we can identify areas where support might help you feel your best. For each symptom below, rate how severe it has been over the past month.
How would you rate any unexplained weight changes (gain or loss) over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate your anxiety or irritability over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate hair thinning or hair loss over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
5. How would you rate low mood or depression over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
How would you rate cold intolerance or feeling unusually cold over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
7. How would you rate heat intolerance or feeling unusually hot over the past month?*

0 = Not Present1 = Mild2 = Moderate3 = Severe
Average Thyroid Hormone Symptom Rating
Body type, goals & nutrition

Based on your body type and weight goals, we’ll create a simple, easy-to-follow meal plan. This plan balances protein, fats and carbs in the right amounts to support your energy, metabolism and overall wellness. Just select your body type and goal, and we’ll add the portions that fit you best to your final wellness plan — no guesswork required.
Which best describes your body type?

Ectomorph / Vata - Lean and slender, hard to gain weight or muscleMesomorph / Pitta - Naturally athletic and muscular, gains muscle easilyEndomorph / Kapha - Soft and round, gains fat easily and slower metabolism
What is your weight goal?

Gain +Maintain ~Lose -
How much caffeine do you consume each day?

None1c. or 100mg2c. or 200mg3c. or 300mg+
How much alcohol do you consume each day?

None/Occasional1 drink/day2–3 drinks/day4+ drinks/day
Nutrition Macro Recommendation
Breakfast for Everyone
Energizing wellness through movement

Your journey begins from right where you are. We’ll match your current exercise level with your body type and goals, creating a realistic path forward so you can stay motivated, supported and on track toward lasting results.
How many days per week do you exercise (any movement counts)?*

0 days1–2 days3–4 days5+ days
How long are your exercise sessions (on average)?*

Less than 10 minutes10–20 minutes20–40 minutes40+ minutes
How would you describe your current fitness level?*

BeginnerIntermediateAdvancedAthlete
Do you have any pain, limitations, or medical conditions that affect your exercise?*

NoneMinorModerateSignificant
How intense do your workouts usually feel?*

None or Very Light (0-4)Moderate (5-6)Hard (7-8)Very Hard (9-10)
What is your current fitness goal?*

Just get moving / rebuild basicsStart being consistentImprove strength / endurancePush myself / level up
Average Fitness Rating
Let's talk about your goals

You deserve a plan designed around your priorities. Rather than trying to take on everything at once, we’ll start with what matters most, meeting you where you are and building habits that last. Share your top goal(s), what comes next and how ready you feel to make changes and we’ll guide you step by step toward lasting results.
Which area of wellness feels most important to focus on right now? *
What would your second wellness goal be once you’re seeing results?*
Please select a different answer than the question above so we can best support your goals.
How ready are you to make changes to your nutrition, fitness and lifestyle?*

Just curiousReady to take actionAlready making changesFully committed
Client Agreement and Informed Consent

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Brain Fog Rating
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