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Hormone Cycle Status
On hormonal birth control
Normal cycle (pre-menopause)
Abnormal cycle (pre-menopause)
Perimenopause
Menopause
Post-menopause
Readiness to make lifestyle changes (5 being the highest)
1
2
3
4
5
Willingness to make a commitment to yourself (5 being the highest)
1
2
3
4
5
Willingness to dedicate resources (time and tuition) to creating a partnership with your body (Highest is 5)
1
2
3
4
5
Did someone refer you?
Yes
No
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