Energy Leves How would you rate your energy throughout the day? Consistently high Energy dips midday Always fatigued None Sleep Quality How well do you sleep at night? Like a baby I wake up occasionally Poor sleep or insomnia None Mood Stability How would you describe your mood most days? Calm and happy Occasionally irritable or anxious Frequent mood swings or sadness None Frequent mood swings or sadness How easily do you maintain or lose weight? Very easy A bit challenging Very difficult None Menstrual or Menopause Symptoms Are you experiencing symptoms such as irregular periods, hot flashes, or night sweats? None Occasionally Frequently None Libido How is your sex drive? Normal or high Lower than usual Almost nonexistent None Stress Levels How do you feel about managing stress? Very well Sometimes overwhelmed Constantly overwhelmed None Time's up
