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Apply To Schedule Your Call With Tafiq

Please fill out this brief questionnaire. At the end of the questionnaire, you'll have the option to schedule a call with Tafiq on the date and time of your choosing. 

Click the button below to start.

Start

Question 1 of 13

Are you currently experiencing any of the 3 stages of menopause: Peri-Menopause, Menopause, or Post-Menopause? 

A

Yes

B

No

C

Not sure

Question 2 of 13

If yes, are you on Hormone Replacement Therapy (HRT) or taking any other medication for menopause?

A

Yes

B

No

C

N/A

Question 3 of 13

What are the TOP 3 most pressing health and wellness CHALLENGES (aside from weight loss) you need help with right now the most? 

Question 4 of 13

Combinations of symptoms are what trigger most negative health and wellness issues. Please check all the symptoms you experience on a regular basis:

(Select all that apply)
A

Trouble falling asleep

B

Trouble waking up in the morning

C

Brain fog/lack of mental clarity

D

Lack of mental clarity

E

Hot flashes/night sweats

F

Low libido

G

Hair loss or thinning

Question 5 of 13

With your job, are you primarily...

A

Sedentary

B

Active

C

I do not work and I'm pretty sedentary

D

I do not work but I'm pretty active

Question 6 of 13

Are you married or have a significant other? 

A

Yes

B

No

Question 7 of 13

Will your spouse or significant other be supportive of you working with a coach to reach your health and fitness goals?

A

Yes

B

No

Question 8 of 13

On a scale from 1-10, 10 being "I'M READY LET'S DO THIS". How ready are you to commit to transforming your health?

Question 9 of 13

 If you are not at a 10, what is stopping you from being at a 10?

Question 10 of 13

Have you invested in your health and wellness in the past?

A

Yes

B

No

Question 11 of 13

If yes, what did you like AND dislike about the experience (please explain in detail)?

Question 12 of 13

How did you hear about me and my program?

Question 13 of 13

Is there anything you'd like to add?

Confirm and Submit