Wellness Welcome Form

Name *

Email address *

What are your primary goals for coaching? *

Please select at least one option.

Managing symptoms

Improving emotional well-being

Enhancing physical health

Building a support network

Accessing holistic resources

What challenges are you currently facing during menopause?

Please select at least one option.

🌡 Hot flashes & night sweats

😰 Trouble sleeping / insomnia

💔 Heart palpitations

🎢 Mood swings

😔 Low mood or sadness

😵 Brain fog / forgetfulness

😰 Trouble sleeping / insomnia

😬 Anxiety or irritability

🍫 Cravings (sugar, carbs, caffeine)

🛑 Loss of motivation

🦴 Bone or muscle loss

❤️ Changes in weight or metabolism

🩺 Concerns about heart or blood pressure

What type of wellness products are you interested in?

Please select at least one option.

Teas

Skin care

Hair care

Supplements

Do you have any specific preferences or allergies regarding products?

What is your preferred method of communication?

What times are you generally available for coaching sessions?

Additional questions or comments

Thank You Sis

Select a date and time *

Select a date and time

September 2018

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Morning

Afternoon

Evening

No availability, try another day

DowMenoLLC

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