Gut Balance Questionnaire
A Happy Gut = A Happy Mind

The brain and gut are closely connected.
Remember those butterflies you feel in your stomach right before doing something that makes you nervous? Or vice versa. What about those "hangry" feelings you get when you need food?

A troubled gut can send signals to the brain, just as a troubled brain can send signals to the gut. If your gut is in distress it can be the cause or the product of...
  • Anxiety
  • Depression
  • Cognitive Abilities
  • Memory
  • Stress
  • Mood Swings
  • Insomnia
  • Fatigue
The third piece of the connection...the axis controls the flow of neurotransmitters and hormones to and from the gut and the brain. Hormones like..
  • GABA – Calming Neurotransmitter
  • Dopamine – Reward Hormone
  • Serotonin – Joy Neurotransmitter
  • Melatonin – Sleep Cycle Regulating Hormone
  • Testosterone/Estrogen – Reproductive Hormones
When the gut-brain axis microbiome is compromised and not balanced, the flow of these hormones are greatly impacted and your mental wellness suffers.

Let's see where you may have some wellness concerns. At the end of this questionnaire you can request more information or help with a supplement protocol. You will also be able to read about some of my more popular supplement packs.
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Sleep
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Sleep is crucial to mental wellness. Sleep allows your body and mind to recharge so that you are refreshed and alert when you wake up. Healthy sleep also helps the body remain strong and fight off diseases. Without enough sleep, the brain cannot function properly.

What best describes your quality of sleep. Select all that apply.
Sleep is crucial to mental wellness. Sleep allows your body and mind to recharge so that you are refreshed and alert when you wake up. Healthy sleep also helps the body remain strong and fight off diseases. Without enough sleep, the brain cannot function properly.

What best describes your quality of sleep. Select all that apply.
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Energy
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What best describes your energy levels on a typical day?
What best describes your energy levels on a typical day?
Focus, Motivation, Memory
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What best describes your cognitive abilities on a typical day? Select all that apply.
What best describes your cognitive abilities on a typical day? Select all that apply.
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Mood
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No feelings of anxiety, stress or sadness.
Strong feelings of anxiety, stress or sadness.
Digestion
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Weight
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Diet & Exercise
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Hormone Balance for Women
Sex or reproductive hormones include estrogen, progesterone and testosterone. PMS, PCOS, Post-partum depression and menopause are all caused by a lack of balance in sex hormones.

When any of these levels are either too high or too low, there is a long list of symptoms that can occur. Young women with heavy periods, severe cramping, acne, bloating and mood swings have high estrogen. Menopausal women tend to have low estrogen and experience hot flashes, mood swings, night sweats, memory lapses, low sex drive and dryness.

Look at the list of hormone imbalance symptoms and select about how many symptoms you experience that you think are a direct result of a possible imbalance.
Sex or reproductive hormones include estrogen, progesterone and testosterone. PMS, PCOS, Post-partum depression and menopause are all caused by a lack of balance in sex hormones.

When any of these levels are either too high or too low, there is a long list of symptoms that can occur. Young women with heavy periods, severe cramping, acne, bloating and mood swings have high estrogen. Menopausal women tend to have low estrogen and experience hot flashes, mood swings, night sweats, memory lapses, low sex drive and dryness.

Look at the list of hormone imbalance symptoms and select about how many symptoms you experience that you think are a direct result of a possible imbalance.
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Hormone Balance for Men
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Men also suffer from a spike or drop in sex hormones especially testosterone and can benefit from balancing these hormones. 

Look at the list of hormone imbalance symptoms and select about how many symptoms you experience that you think are a direct result of a possible imbalance.
Men also suffer from a spike or drop in sex hormones especially testosterone and can benefit from balancing these hormones.

Look at the list of hormone imbalance symptoms and select about how many symptoms you experience that you think are a direct result of a possible imbalance.
What are your top 3 wellness goals?
Thank you for sharing!
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Is there anything else that you think would be helpful for me to know prior to making a biotic and hormone balancing protocol suggestion?
Is there anything else that you think would be helpful for me to know prior to making a biotic and hormone balancing protocol suggestion?
First Name
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Last Name
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Cell number or email address (double check for accuracy). Check your spam folder if you don't get a reply in 48 hours.
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How did you find this Wellness Questionnaire?
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Are you ready to get started?
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Let's say you love how you are feeling (you will) and decide you want to share about it. Would you rather earn free product or $$?
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What can you expect?

1. Privacy, compassion and a genuine concern for your well-being.

2. A reach out if I have any other questions and/or to share with you a specific biotic and hormone balancing protocol suggestion, and a link to a cart with those products.

3. An opportunity to join a private Facebook group full of testimonies, product specifications, and knowledge based interviews and videos.
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