Your Pre-Consultation Materials

Details

Most women spend 60–90 minutes completing the form. You can complete it in one sitting or return to it as needed — the form automatically saves as you go.

The form includes:

  • Your medical history and previous care

  • Current symptoms and concerns

  • Menstrual, perimenopausal, or menopausal patterns

  • Medications and supplements

  • Lifestyle factors (sleep, stress, exercise, nutrition, etc.)

  • Your goals and what you hope to get from this work

Comprehensive Intake Form

Complete Form

3-Day Food Journal

Details

  • Record everything you eat and drink
    (include type, preparation, and approximate amount)

  • Note the time of each meal or snack

  • Include how you felt within two hours
    (still hungry, tired, energized, bloated, foggy, or anxious, etc.)

How to complete it well

  • Fill it out as soon as you can after eating

  • Don’t change how you normally eat

  • Be as specific as you comfortably can (e.g., “whole milk,” “brown rice,” “2 tsp butter”)

  • Include all beverages, including water

  • Note even small changes in how you feel after meals — they help me see patterns

    Use the PDF to write directly or print it — whichever is easiest.

Complete Journal

6 Week Follow Up

Details

  • Most women spend 15–20 minutes completing this form. You can complete it in one sitting or return to it as needed — the form automatically saves as you go.

    The form includes five reflection questions:

    • What symptoms you're still or now struggling with

    • What has improved or changed for the better since your last visit

    • What has not improved or has worsened

    • Major life events that have happened since your last visit

    • Obstacles you've faced in following your health plan

    This reflection helps us track your progress, understand what's working, and adjust your care plan to better support you moving forward.

Complete Follow-up