You're In!

Quick Fit — check any that apply

□ I’m 40–55 and noticing changes in sleep, energy, mood, or cycles
□ I want clear education and simple steps (not one-size-fits-all advice)
□ I can give ~10 min/day or ~60 min/week
□ I’m open to lifestyle changes before/alongside supplements/meds

Rate each 0–3 (0 = none, 3 = major)

Sleep quality: 0 1 2 3
Daytime energy: 0 1 2 3
Mood swings / irritability: 0 1 2 3
Brain fog / focus: 0 1 2 3
Hot flashes / night sweats: 0 1 2 3
Cycle changes: 0 1 2 3
Stress reactivity (easily amped): 0 1 2 3
Weight / waist change: 0 1 2 3

Capacity & logistics (Yes/No)

Yes / No — I can commit 10 min/day or 60 min/week
Yes / No — I’m willing to track sleep/steps/protein for 2 weeks
Yes / No — I’m comfortable using Zoom / client portal / app

Mindset (Yes/No)

Yes / No — I’m ready to adjust my evening routine to support sleep
Yes / No — I can protect a small, consistent weekly time block

Your Readiness Snapshot (choose one)

○ Green — Ready to Shift (most items 0–1; only a few 2s)
○ Amber — Foundation First (5+ items at 2–3 or limited capacity this month)
○ Red — Stabilize (any safety flag: chest pain, suicidal thoughts, post-menopausal bleeding → see your clinician)

Jot your notes before booking
Priority 1: __________
Priority 2: __________
First habit I’ll try: __________
Questions for Liza: __________

Educational only — not medical advice.