top of page

Request a Consultation


Stepping into your second act (your next phase of health, vitality, and personal renewal—typically in your 30s, 40s, 50s, and beyond) is an opportunity to reclaim your health, vitality, and confidence—but navigating this transition can feel overwhelming. You don’t have to do it alone.This consultation is your first step toward gaining clarity, understanding your body’s unique needs, and creating a personalized strategy for lasting well-being.


To ensure I can provide the most insightful and effective guidance, please take a few moments to complete this form. Your responses will help me better understand your current challenges, goals, and health history.


Once submitted, I will review your information and reach out within three business days to schedule your consultation. I look forward to connecting with you and helping you step into your second act with confidence, energy, and resilience.


Thank you for taking this step toward empowered, proactive health!

Availability

Select all that apply

Birthday
Month
Day
Year
How would you describe your current menstrual status?
Premenopause (having regular periods)
Premenopause (no periods due to hormonal birth control)
Perimenopause (having irregular periods &/or symptoms)
Perimenopause (symptoms but no periods due to hormonal birth control)
Postmenopausal (no periods in over 12 months)
If postmenopausal, was it:
N/A
Spontaneous (occurred naturally)
Surgical (removal of both ovaries)
Due to chemotherapy or radiation therapy

If you are not able to contact your mother please put I don't know.

Do (or did) you experience PMS?
Yes
No
I don't know

Light, heavy, short, long, irregular, painful, etc.

Select all that apply

Do you conduct regular breast self-exams?
Yes
No

Please also note if you are on HRT and/or SSRIs.

How many hours of sleep do you average per night?
≤5
6-7
8+

Select all that apply

Symptom Experiences


Below are all potential symptoms that you could be experiencing during perimenopause and beyond. Please take your time to go through each one and answer the most fitting answer as of now:

How would you rate your typical energy levels?
Low
Moderate
High
How do you view menopause?
Positively
Negatively
Neutral

Such as loss of a loved one, job changes, divorce, relocation, etc.

bottom of page