Thank You for taking time out of your day!

HELLO beautiful!

Thank you SO much for your contribution here!

The goal of this survey is to get in touch with YOU. A woman in her reproductive years. To get a better idea of the type of health challenges you've encountered.

Your answers here are SO much appreciated.

You don’t have to share anything you don’t feel like sharing but if you think it may help other women, I encourage you to share anything that comes to your mind.

Beofre you start, I suggest you to scan through ALL of the questions first so you don't have to write things twice.

Thank you again!!!

p.s. I SO look forward to chatting with you for 15 minutes (ideally over the phone/FaceTime/Whatsapp/Skype call) about all things health. Whether you want to run your routine by me, or if I have suggestions for you, or if simply sharing my story helps you in any way - I live for this and can't wait!

HELLO beautiful! Appreciate you so much!

Thank you for taking time to contribute!

The goal of this survey is to get in touch with YOU. A woman in her reproductive years. To get a better idea of the type of health challenges, obstacles, and successes you've experienced/are experiencing.

Your answers here are SO much appreciated.

You don’t have to share anything you don’t feel like sharing but if you think it may help other women, I encourage you to share anything that comes to your mind. Your answers are 100% confidential. You also don't have to fill out your name and personal info at the bottom if you prefer not to.

Before you start, I suggest you to scan through ALL of the questions first so you don't have to write things twice.

Thank you for your contribution!!!

P.S. I SOO look forward to connecting with you for 15 minutes to discuss all things health. Whether you have questions, or I have suggestions for you, or if sharing some of my story helps you in any way - I'm game for it and hope you are too.

xoxo!

Asma

Were you athletic growing up? Did you play sports? Explain a little

List 3-5 words that describe you/your personality type *

What (if any) weight-related struggles have you had over the past 5, 10, 15 years? (Would love to hear a bit about your journey) *

Have there been any other health/wellness/fitness challenges you've had in the past? *

What (if any) diets, cleanses, programs have you done? (Weight Watchers, Keto, Atkins, programs suggested by Doctors, Naturopaths). *

Do you do any of these programs still? Or do you follow any other nutrition guidelines? Why? *

Which of these programs had the largest impact on you? What did it/they teach you? *

Off the top off your head, what has been the BEST piece of health advice that's always stuck with you *

Do you currently exercise? How many times a week? How long *

What type of exercise do you do? *

Do you drink Alcohol? How much? In what environment usually? *

Other than diet and exercise, are there any other practices that you engage in for health benefits? (again no right or wrong. ANYTHING you do that helps you with your physical or mental health) *

Describe your emotional health *

Do you have children? *

Do you experience regular or irregular periods?(regular=every month for about a week; irregular=skip months, super short or long periods) *

Do you experience PMS symptoms? Check any that apply *

What is your age? *

What are some of your NEW/CURRENT health goals or challenges that you need help with or are getting help with? *

How are your stress levels? *

Thank you! Now PLEASE tell me when you are generally available to chat for 15 mins.(Available days: MON/WEDS/FRI/ SAT). I will email you some options and you pick the time! *

Anything else you feel is relevant to share is MORE than welcome!

Name *

First Name Last Name

Email *

example@example.com

Phone Number

Area Code Phone Number