Hormone Type Assessment Questionnaire Form
Complete this questionnaire to help identify general patterns related to your hormone type. This is a general wellness assessment and does not collect sensitive health information.
How would you describe your typical energy levels throughout the day?
*
Consistent all day
High in the morning, lower in the afternoon
Low in the morning, higher in the evening
Fluctuates a lot
Other
How would you rate your average stress levels?
*
1
2
3
4
5
On average, how many hours of sleep do you get per night?
*
Less than 5 hours
5-6 hours
7-8 hours
More than 8 hours
How often do you feel sudden changes in mood or irritability?
*
Never
1
2
3
4
Very Often
5
1 is Never, 5 is Very Often
Please indicate your typical appetite patterns.
*
Consistent throughout the day
Very hungry in the morning
Very hungry in the evening
Rarely feel hungry
Please rate the following aspects of your daily routine.
*
Rows
Rarely
Sometimes
Often
Always
Feel refreshed after sleep
1
2
3
4
Experience afternoon slump
5
6
7
8
Crave sweets or carbs
9
10
11
12
Feel anxious or restless
13
14
15
16
How would you describe your ability to concentrate or focus?
*
Very good
Good
Average
Poor
How frequently do you feel fatigued despite adequate rest?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How would you rate your motivation to be physically active?
*
1
2
3
4
5
Please share any general patterns or observations about your daily well-being that you think are relevant.
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