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Section 1: Your Health Goals & Motivation

What are your health goals, and what is your motivation behind them?

Of your goals, which one is most important to you right now, and why?

What have you tried in the past to achieve these goals? Were you successful? What worked, and what didn’t work?

If you could change one thing about your health right now, what would it be?

Where do you see yourself 6 months from now if you stay on your current path? Where would you love to see yourself instead?

Section 2: Hormones & Health History

Are you currently in perimenopause, menopause, or post-menopause?

Do you experience any hormonal symptoms (hot flashes, PMS, irregular cycles, etc.)?

Do you currently have any known health conditions? (e.g., high blood pressure, thyroid issues, diabetes, high cholesterol, autoimmune conditions, etc.)

Are you on any prescription medications? Do you currently take any supplements?

Do you have any allergies or food sensitivities?

Do you experience any digestive issues? (e.g., bloating, constipation, reflux, etc.)

Section 3: Sleep, Energy & Mood

Tell me about your sleep: How many hours do you get? How well do you sleep? Is your schedule consistent? Any recent changes in sleep patterns or quality?

How would you describe your daily energy levels? (e.g., steady, crashing mid-day, always tired, etc.)

How would you describe your overall mood most days?

Section 4: Hydration & Nutrition

How much fluid do you drink each day? What do you drink (water, coffee, alcohol, juice, etc.), and how much of each?

Do you feel generally hydrated? Do you add anything to your water (flavoring, electrolytes)?

What does your current eating look like? (What types of food do you eat — fast food, processed foods, whole foods, etc.? How often do you eat? Do you practice any type of fasting?)

How many times a week do you eat out? (Fast food or sit-down restaurants?)

What are your biggest challenges with food? (Cravings, emotional eating, portion sizes, meal planning, or something else?)

Do you track your food or activity in any apps? If yes, which ones, and how often do you use them?

Section 5: Movement & Physical Activity

How many hours a day do you sit? (Work, driving, watching TV, etc.)

How much movement do you get each day? (Cleaning the house, chores, walking, etc.) What do you enjoy about moving your body, if anything?

Describe your exercise routine: How often do you exercise? What kind of exercise do you do? How hard do you work out, and how long are your sessions?

Section 6: Stress & Self-Care

Rate your daily stress on a scale of 1–10. What is the primary cause of your stress?

What do you do to relax or unwind?

How much time do you feel you dedicate to self-care each week?

Section 7: Toxins & Detox Readiness

How often do you use plastic containers or drink from plastic bottles? (Daily, a few times a week, etc)

How often do you use non-stick pans (like Teflon) for cooking? (Daily, sometimes, rarely, never)

How often do you use conventional household cleaning products (store-bought sprays, bleach, etc.)? (Daily, weekly, occasionally, never - I use natural alternatives)

How often do you use personal care products that may contain synthetic fragrances (lotions, perfumes, deodorants, etc.)? (Daily, weekly, occasionally, never)

Do you drink filtered or purified water at home? Bottled? Tap?

Have you noticed symptoms such as headaches, fatigue, brain fog, skin issues, or unexplained weight gain? If so, which ones? For how long?

How often do you consume conventionally grown (non-organic) produce or animal products? Which ones?

Are you regularly exposed to chemicals or pollutants at work or home? (if yes, please describe)

Have you ever done a detox or cleanse before? If yes, what kind and what was your experience?

How interested are you in learning more about gentle detox strategies to support your overall health? (Very interested, somewhat interested, not interested)

Section 8: Mindset & Support

On a scale of 1–10, how ready do you feel to make changes to your health habits right now?

What potential obstacles do you feel might get in the way of your success?

Who supports you in your health journey? (Family, friends, community, no one at the moment)

Do you currently work with any other health professionals? (e.g., doctor, dietitian, therapist, trainer)

Final Thoughts

Is there anything else you'd like me to know or any specific concerns you'd like to share?

Thank you!

Thank you so much for taking the time to share this information. This helps me create a personalized and supportive plan designed just for you!

Led by a Registered Nurse. Backed by real solutions.

Thank you!

Led by a Registered Nurse. Backed by real solutions.

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Let Tina help you discover the healing power already within you.