ASSESSMENT | Naturally Minded Program

Have you ever been diagnosed with any form of thyroid disease?*

Women - do you suffer from PMS, irregular cycle, menstrual migraines, fibrocystic/sore breasts, uterine fibroids, or menopausal symptoms?*

Women - have you ever had a bad reaction to birth control pills?*

Men - have you lost weight without trying to, or lost strength/muscle mass?*

Do you need coffee to get going in the morning?*

Do you feel exhausted all day and then have trouble sleeping at night?*

Do you ever feel overwhelmed by small, everyday stressors?*

Has your sex drive disappeared?*

Do you frequently wake up in the middle of the night and have trouble falling back asleep?*

Do you ever wake with heart palpitations, a racing or pounding heart, or feelings panic or anxiety?*

Are you sensitive to salt? (Do you gain weight overnight after eating in a restaurant of after a salty meal?)*

Do you feel calmer after eating?*

Do you have cravings for sweets, bread, cereal, crackers, or chips?*

Do you have trouble controlling how much bread or dessert you eat once you start eating it?*

Do you feel tired all the time?*

Do you feel depressed or have no motivation to do anything?*

Have you followed a weight loss program and not lost weight?*

Do you usually feel colder than the people around you?*

Are you very sensitive to changes in temperature or feel you have trouble regulating your temperature?*

Has your hair thinned significantly over a short period of time?*

Does your mood change rapidly, sometimes without reason?*

Do you have night sweats?*

Do you have “brain-fog?” (trouble focusing, making decisions, feeling motivated)*

Do you feel anxious or on-edge most of the time?*