Menopause Wellness Survey

This survey is designed to understand your menopause journey better. Your responses are confidential and will help shape the Menopause Wellness Summit experience. Thank you for sharing your insights.

Full Name

Email *

Age:

35–40

41–45

46–50

51–55

56–60

61–65

Which stage are you currently in?

Perimenopause

Menopause

Postmenopause

Not sure / Prefer not to answer

Which symptoms do you currently experience or have experienced? (Select all that apply)

Hot flashes

Night sweats

Mood swings

Sleep disturbances

Low energy

Changes in metabolism or weight

Memory or focus changes

On a scale of 1–10, how much do these symptoms impact your daily life?

Not at all impactful

Mild impact

Moderate impact

Significant impact

Extremely impactful

Which wellness areas are most important to you? (Select up to 3)

Sleep

Hormone balance

Energy & vitality

Nutrition & metabolism

Fitness & movement

Mental health & mindfulness

Community & connection

Are you currently taking hormone therapy?

MHRT (Menopause Hormone Replacement Therapy)

BHRT (Bioidentical Hormone Replacement Therapy)

Both MHRT and BHRT

No hormone therapy

Considering hormone therapy

Not sure

What types of support would be most valuable for you? (Select all that apply)

Expert guidance / education

Practical wellness tools / tips

Online communities / discussion groups

In-person events / workshops

Personalized health coaching

How likely are you to attend the Menopause Wellness Summit?

Very likely

Likely

Unsure

Unlikely

What would motivate you to attend a summit like this?

Which topics or speakers would you like to see included?

Would you like to schedule a complimentary 15-minute consultation with a Menopause Specialist?

Yes, I would like a consultation

Maybe, I would like more information first

No, I only want menopause resources

Phone Number *

Best time to contact you:

Morning

Afternoon

Evening

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