FYP: Quiz - Nicole Jardim

Important: When you answer the questions, please tell me what's happening right now with your menstrual cycle. This will allow me to more accurately assess your health concerns.

Once you fill out the form below and submit your answers, you will immediately be taken to the 1st lesson of your customized Fix Your Period Quickstart Kit. Plus you will receive an email with your specific results.

*denotes a required field

*1. Which of these best describes your menstrual cycle CURRENTLY?

*2. If you currently get your period, how many days does your period last (not including spotting before and after your period)?

*3. If you currently get your period, how often do you change pads or tampons?

*4. Are you currently using hormonal contraceptives/birth control? (This includes the birth control pill, patch, IUD, implant, & Nuvaring)

*5. Have you been diagnosed with OR are you currently experiencing any of the following?

To select multiple: Hold Command (Mac) or Control (PC) on your keyboard and select

*6. Do you currently struggle with physical OR emotional PMS symptoms that disrupt your life? (Low mood, anxiety, anger, bloating, weight gain, acne, crazy cravings, breast tenderness/swelling?)

7. Do you experience any of the following at any time during the month?

To select multiple: Hold Command (Mac) or Control (PC) on your keyboard and select

*8. At the beginning and during my period, I experience:

*9. Do you feel tired and weak leading up to your period, OR do you generally feel fatigued at other times in the month?

*10. You aren’t able to get rid of excess fat or lose weight no matter what you do.

*11. When you wake up in the morning how’s your energy level?

*12. You look in the mirror and notice a huge zit….

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